Definition, taken from a newsletter of the MS Society on Exercise and MS: “Multiple sclerosis, an unpredictable, often disabling disease of the central nervous system, interrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.”
I had and have the privilege of working with five clients who have MS, and I am very happy to report that every one of them has improved in function. While five clients hardly represent a sizeable number for any study, I have observed a few things that all of them had in common and which I want to share.
I cannot imagine how I would feel on first receiving the diagnosis of MS; depressed would be among the first. Because of its unpredictability, it’s impossible to know how bad it will be and where it will end. MS symptoms are usually progressive, but the progression is not necessarily linear. There are good days, and there are bad days. Since MS usually affects the way a person walks, this shift in gait often leads to secondary problems with hips, lower back and knees which have nothing directly to do with MS. The resulting pain makes people often more sedentary which in turn exacerbates the problems further.
I have seen that clients with MS usually are in much worse shape than they need to be if they just knew how to counteract some of the growing limitations.
On a bad day, a client may have a very hard time walking but that does not mean that she has now reached a new low and that the necessary adaptations for that one day have to be here to stay. And yet, that seems to happen very often. We all know that a body adapts to new patterns of movement rather quickly, MS or not, and I have observed repeatedly that gait can be improved just be illustrating that a more ‘normal’ pattern is possible.
MS tends to impact one side more than the other, and hip and dorsiflexion are often problematic which leads to the characteristic swing gait. I have observed that those movements can be improved if there is still a connection. I have also witnessed that a seemingly dormant movement can all of a sudden ‘kick in’ when solicited with eccentric loading. There is nothing more rewarding for a trainer than to watch this happening.
It takes a bit of sleuthing to find a way to work a muscle when traditional exercises are not possible but a combination of isolation and integration can often lead to encouraging results. Once gait and posture improve, the secondary problems also diminish. Needless to say, having less pain and an improvement of function and stability provides a much better outlook on life and can reverse the downward spiral physically and emotionally.
Having recently been in Charleston and gone on a ‘Ghost Tour’, Halloween approaching and one of my clients proudly telling me that she had bought a skeleton at a Halloween store, I, too, became inspired to get a small plastic skeleton. And since things must have a name, I decided to call him (it is indeed a male skeleton) Skelly.
Whether I teach a class or train a private client, I always want to educate as well as provide a good workout experience. Analogies are my favorite ways of relating things, but nothing beats visual tools, and I almost wonder what took me so long to get Skelly.
This morning, he had his first semi-public appearance as I was talking about the role of a quadriceps and why it gets tight. Or, to be more specific, why only one of the four quadriceps muscles, the rectus femoris, gets tight. It’s the one that is bi-articular and crosses the hip and the knee joint and thus is always in a shortened position when sitting. It was not the first time I had talked about it but the effect today truly created an understanding as I used my dynaband to simulate the rectus femoris and its position relative to the two joints it crosses. As they say: a picture is worth a thousand words.
This coming Monday, though, Skelly will need to be on my porch to scare all the little goblins who are bound to threaten with a trick but will settle for a treat.
A year ago today was the last day my husband was able to walk in his own house, even though it was so difficult for him, that it was painful to watch.
The next day, he could not stand up at all and fell down trying. Needing help getting back up was the greatest humiliation for him but I could not do it by myself and ended up calling 911 for assistance. He did not want to go to the hospital but agreed to it a few hours later. He was not able to move his left arm and leg and could not even sit up.
At the hospital ER, the doctors finally found the reason for his complete lack of making the expected progress. He had an infection in the brain. The surgery next day revealed the extent of the damage; the infection had eaten through the dura, a protective membrane for the brain.
When I saw Rufus after the surgery, we had a very fleeting moment of celebration: he could raise his left leg and squeeze my hand with his left, and when I went to bed that evening, I was convinced that we had turned the tide and that recovery was ahead of us even if much more complicated than expected.
The next day, there was no movement. It would never be again.
There is something about the Olympic Games which set them apart from any other sport event. The scale in terms of events and number of athletes; the triumphs and heartbreaks; the potential of human performance.
The dedication of the athletes is beyond anything I can imagine. Their lives are subordinated to the goal of running just a little faster, jumping just a little higher or adding just a greater level of difficulty to the gymnastics routine. The difference between winning the gold medal and capitalizing (deservedly) from it and ending up as number 4 in the race and never heard from again can be as little as 1/10th of a second. I don’t condone but I understand why the temptation to taking performance enhancing drugs is very strong.
At the same time, for every Olympic event there is a perfect body type. I was struck by the difference in physique between the 50 m freestyle races and all the other distances. Those swimmers were specialists in that one race and did not compete in any of the others. Michael Phelps certainly achieved his superhuman performances because of willpower and skill but also because of genetics which endowed him with a body of unusual proportions which happen to be perfect for swimming.
I had a wooden plank in my studio during the Olympics which became my surrogate for a balance beam. With the surface ½ inch off the ground, it seemed a great way to get perspective without taking any risk. I tried to spin on it and keep my balance – well, no. Then I tried to jump up, not a split, just a little hop. And that was all it was. My feet may have left the board 1/8 of an inch. And it had nothing to do with the fact that I am, ahem, well out of the Olympic age range.
I love how the Olympic Games bring the world together for 2 weeks every 4 years and help bring down walls.
My husband and I are great believers in the power of positive thinking, and studies after studies have demonstrated that the firm believe in a positive outcome is a powerful determining factor in the final result.
My husband’s surgery was scheduled to July 21, and here is what he wrote his clients on the evening before:
“I have been diagnosed with a 'Benign Tumor of Cerebral Meninges'. According to the Neurosurgeon, this is a very common occurrence. However, most growths do not get large enough to cause issues. Mine has gotten large enough, so it has to be removed. The Neurosurgeon said I am lucky to have this type of condition because he 'pops' them all the time. Fortunately it is non-malignant. However, to be a 100% sure, they have to diagnose the mass once it’s removed.
I am scheduled to have the surgical procedure on Tuesday, July 21st. The procedure should take about 1 1/2 hours. I should be released from the hospital on Thursday, July 23rd. I will rehab the rest of the week and be good to go with my regular schedule on Monday, July 27th.
Currently I feel great. I have been taking medication to reduce inflammation. We had a wonderful conference. I will be working my regular schedule on Monday, July 27th.
After reading this, even I, with all my positive thinking, pointed out that this seemed to be overly optimistic and that he should maybe give himself a few extra days of rest but my husband had nothing of it and sternly admonished me that you always assume the best possible scenario.
And thus started the first day of the last 5 months of his life.
When I complete an assessment prior to training, the focus is on alignment and posture. I try to identify what’s shortened, what’s lengthened, what’s twisted and what’s straight. I take pictures to show it to clients, and the response is usually “I had no idea”, followed by “What can I do about it?”
At that point, I talk about the different levels of competence:
Unconsciously incompetent: that is the stage when somebody is not even aware that something is amiss.
Consciously incompetent: here the client is made aware of deficiencies, and they rise to the levels of consciousness about the problem.
Consciously competent: we are working on corrective measures, and the client has success in seeing how the strategies bring the client to improved posture. However, the client has to make a conscious effort to maintain it.
Unconsciously competent: now things have become second nature, and no effort is required to maintain good posture. I often tell clients that they will know that “they have arrived” when slouching starts feeling uncomfortable.
We often start a narrative with those words. It marks always a day when things happen that impress themselves permanently on our memories.
July 1st, 2015 was such a day. I was taking a shower when the shouts of my husband’s client alarmed me. Getting out of the shower and covered as fast as possible, I saw my husband Rufus in a chair in the living-room, his left hand moving strangely. He was visibly shaken. I called 911 immediately and reported the suspicion of a stroke. Within minutes, the fire engine arrived, shortly followed by EMS. The guys and gals were absolutely fabulous, giving a great sense of relief in a tense situation.
Rufus was taken to the emergency room and immediately had a CT scan. When I arrived at the hospital, dried and dressed, I had to wait for him. He looked still a little shaken but seemed no worse for wear except for an IV sticking in his arm. Shortly thereafter, we got the preliminary result: it had not been stroke but the symptoms were triggered by a meningioma, something that we had never heard of. We were informed that that was actually good news because it is a benign brain tumor which is not at all uncommon. They often go undetected when they do not cause any symptoms. Since that one had, the surgeon recommended surgery sooner rather than later, and Rufus readily agreed.
To rule out any other possibilities, Rufus stayed in the hospital for another day for more tests and was then discharged with the usual instructions and a whole battery of pill bottles. The surgeon suggested surgery the following week. We had, however, planned to attend the IDEA World Fitness Conference which was scheduled for July 15 to 19, and even my always optimistic husband did not think that he would be recovered soon enough to have a surgery on the 6th of July and then go on a trip a week later. He negotiated a later date for the surgery, just after the conference, and the surgeon had no objections.
We congratulated ourselves on our good luck and proceeded with our lives, a little shaken by such a sudden turn of events but confident that nothing major really had happened.
I just resigned from Rex Healthcare after more than 20 years of service. The following are the events leading up to this decision:
My husband died almost 5 months ago. He had acquired an infection in the brain during a surgery to remove a benign brain tumor. The complication brought on bleeding in the brain and a massive stroke which left him paralyzed on the left side of his body to the degree that he could not even sit up or turn himself over in the bed. He was completely dependent, a fate that most people would consider worse than death, and he certainly viewed it that way.
He suffered all the indignities that go along with such total dependency, and in the end all I could do is take him home and afford him the comfort to die at home in familiar surroundings with friends visiting him to the very end.
Never in my worst nightmares could I have imagined such a scenario. The week before the surgery, my husband and I had made our annual trip to the IDEA World Fitness Convention in California. He even indulged my craving for art, and we visited the Getty Museum together on a beautiful California day.
I have been a wellness instructor at Rex Hospital for more than 20 years, teaching first water aerobics and then MELT. I had always been proud to be associated with Rex Hospital, and when my husband needed to be admitted to a hospital, Rex was my first and only choice.
Watching the proceedings leading to my husband’s death has caused me a great deal of anguish as I dealt with my increasingly ambivalent relationship to Rex. My first impulse was to resign, and I did not teach any classes at all for several months. I had a sense of loyalty, though, if not so much to Rex as to the members of the wellness center, and decided to teach on a very limited base. Stepping back on hospital grounds was more difficult than I had imagined. I had made the trip to the hospital over and over again during the months of my husband’s hospitalizations and rehabilitations.
It is not easy to get one’s life back together after events like those. I know that many other people have suffered a similar fate but this is of very little consolation. In addition to the grief, there is anger over an unnecessary death. My husband should still be alive, and we should be planning for our next conference. His clients should still have a trainer, and I should still have a husband. Thoughts like that rear up even if one tries to ‘move on’ as the saying goes.
I was dealing with all that when I got an unexpected piece of mail this week. Rather, it was a mailing addressed to my husband. Of course, much mail is still addressed to him but the sender of this letter was unique. It was a letter from the Rex Healthcare Foundation and it was the request for a donation so that Rex can continue to provide excellent care to its patients.
At first, I was baffled. Then I tried to decide whether to laugh or to cry. The longer I looked at the letter, the angrier I got. I wrote a cynical note to the Rex Healthcare Foundation which made me feel a little better temporarily. I felt and still feel as if somebody had slapped me in the face, adding insult to injury. I have been trampled upon by a hospital bureaucracy that simply doesn’t give a damn. Pardon my French, I am usually not given to outbreaks of profanity. This is how I feel: “How dare they send this letter? First they kill my husband, and then they have the nerve to send this!”
I cannot possibly continue to be associated with an organization where such instances can occur. Yesterday, I sent my letter of resignation.
Not too many years ago, the term “fascia” was hardly heard. It was viewed as the body’s inert ‘packaging material’ just as bubble wrap or packaging peanuts. It was also regarded as the domain of hands-on bodyworders such as massage therapists and Rolfers. This view has changed radically over the last years, and its wording has begun to infiltrate the fitness industry.
Let’s go back to basics with a definition of what “fascia” actually is. It is not so much packaging material as it provides a stabilizing structure in the body. Better known examples of fascial tissue are tendons and ligaments, the plantar fascia and the notorious IT band. But it goes well beyond that in that it surrounds every bone, every muscle and even every muscle cell. Think of it as the membranes of an orange which give the fruit its shape.
The fascia in the human body creates an internal scaffolding which can reorganize itself constantly to the requirements of movement and rest. It is a fluid filled system based on collagen. Because of its job as a support structure, it provides stabilization particularly for those postures and movements which we execute repeatedly. It accomplishes that but laying down extra tissue much as we would use duct tape to reinforce weak structures.
Unfortunately, the one position that we as humans in our modern world assume the most is sitting, be it at a desk, in the car or even for recreational activities such as reading. When fascia deforms and reinforces itself to accommodate a sitting posture, it becomes denser (de-hydrated) and loses its ability to extend easily to provide support for other positions such as standing and walking. The consequences of this discrepancy are frequently shoulder, neck and low back pain.
Another important aspect of fascia is that it is the host tissue for a variety of sensors which form part of our autonomous nervous system. I am right now only referring to the sensors (mechanoreceptors) which allow us to sense ourselves in space, also called ‘proprioception’. (There are others but this would lead us too far.) When those sensors are in the healthy environment of easily moveable fascia, they can sense their surroundings with accuracy and relay this information rapidly so that subsequent movements can be executed correctly. Watching athletes gives an excellent opportunity to see this perfect response, be it a downhill skier or a basketball player. However, when those sensors happen to be in areas of dehydrated fascia, then the sensory input is skewed, and information travels at a slower speed. A very sad example of such flawed input and slow response is when people, often older, fall. The main reason why those falls can have such catastrophic consequences is that no corrective response occurs to counteract the fall. Simply put, by the time the information about the impending fall has been received by the brain, the person has already fallen without any attempt at bracing the fall.
With all this said, it seems obvious that we should take care of our fascia much as we take care of our skin and teeth.
As an instructor for MELT (Myofascial Energetic Length Technique), TBMM (The BioMechanics Method) and (soon-to-be) RTR (Relief through Rolling), foam rollers and balls are my preferred method of massaging and manipulating fascia with the goal of lengthening and re-hydrating this tissue. The beauty of all these techniques is that they are meant for self-treatment, and a participant in a class will have take-home techniques.
At the last personal training conference, I attended a session on “Posture and Core for the Aging Spine” presented by Shari Kalkstein.
I walked away with many good ideas on how to work the core without further jeopardizing clients with osteoporosis but I also learned one fact that I had not known before.
I knew that not only women can get osteoporosis but also men. I had heard the statistics of a ratio of about 1 : 10. I have never really questioned it. It was in my textbooks, and I did not give it any further thought.
While is seem to be true that women are at greater risk for osteoporosis than men, it is definitely true that men are not screened for it. In fact, I do not know of one man who had been screened for osteoporosis. That makes me wonder whether the low prevalence is the result of lack of early detection and not because of the fact that “men are at much lesser risk”. A google search revealed that men are more likely to die after a hip fracture than women.
So here is my suggestion if you are a guy: talk to your doctor to see whether a screening for osteoporosis is right for you.