Movement Quality, Health and Fitness

When it comes to movement quality and fitness, nature had it right all along.

Developing movement quality before fitness is hard-wired into us.

We crawl before we walk.

We walk before we run.

First we develop the quality and control of movement. Then we start doing more of it, which develops our capacity of movement (fitness).

This is the pathway that humans have followed forever, until recently.

Now, around about the age of 5, we send children off to school, where they learn to sit still. We even give out stickers to the kids who do it best.

At this age, things aren’t too bad though. We have about 4 years of movement “training” under our belts compared to 1 year of sitting.

Fast forward to age 10, and that ratio is now 4:6, not great, but still not too bad.

Let’s accelerate to 18, when most kids, now young adults are graduating from high school.

They’ve now been sitting for the majority of their day for 14 of their 18 years.

Many would have played sports recreationally, and suffered injury as a result.

Can you see the problem?

And we are only looking at an 18 year old, who for all intents and purposes, is in the peak of youth, and physical potential.

What happens when we hit 40, 50 and beyond?

Fitness First, Then Injury?

You’d think getting fitter and healthier would be easy. Our bodies are designed to thrive after all.

The problem is, people start out with poor general health.

Think of the average person over 30. They are likely over stressed, possibly anxious or depressed. Body functions like their digestion, elimination and breathing are dysfunctional. Their physiology is impacted by poor sleep quality and quantity, and abnormal light exposure. And, they aren’t moving at all, with the average Australian clocking in at a measly 4000 steps per day. (1)

For the average person who decides to take action and make themselves healthier, it’s an uphill battle before they’ve started.

So when they start exercising with intense, and often short term programs, they are actually adding more stress on to an already stressed body. Combine this with a restrictive diet, and the situation becomes even worse.

It doesn’t take a genius to work out that this might be too much.

Get Healthy First

What should you do instead?

Before you jump head first into an intense exercise program, commit to walking*.

Sounds too easy?

That’s the point.

If you walk daily, you experience a myriad of health benefits that compound. This sets you up for more intense work in the future, if that’s your goal.

Walking is sustainable, so you can do it for the rest of your life (and you should).

You can walk outside, which is ideal, but if weather or safety doesn’t permit, you can walk on a treadmill.

The whole point of starting with walking, is that it is supposed to be mentally and physically achievable. Success breeds success.

All this walking will:

  • Reduce your stress levels
  • Improve your body composition
  • Improve your cardiovascular health
  • Allow you some “down time” in our constant “on” world

This in term will help you sleep better, so your mood improves as your brain and hormones start to balance out.

As a result, it becomes easier to improve your diet, because you aren’t fighting against a stressed out and fatigued brain that wants quick fixes of sugary, salty and fatty convenience foods.

The principles of a healthy diet are simple. Changing your diet is not, because it is about changing your habits.

For most, the best approach is to work with a dietitian or nutritionist. Because in most cases, it isn’t a lack of information that stops people making change. Everyone knows they should eat more vegetables, but most don’t eat enough.

If you can’t, or don’t want to, you can try and change yourself.

For the best chance of success, you want to change one thing at a time. This is why I recommend walking first. It establishes a healthy habit which can have a snowball effect.

With nutrition, change one meal at a time.

Check out the Australian dietary guidelines. Then, starting with breakfast, look to improve your diet one meal at a time. Once a breakfast becomes a healthy habit, move on to lunch and so on.

If you can start walking regularly, and get your diet in order, you are more than half way to a healthy lifestyle that minimises your risk of all kinds of diseases.

This also enhances your quality of life, which is often overlooked – it’s not just how long you live, but how well you live.

This process might take time. Months, even years for some. So it is important to learn how to relax, both physically and mentally.

You can’t keep putting stress upon stress and expect good results, let alone good health.

Learning how to relax physically and mentally allows your body to recover, which is when your body repairs and your health improves.

Everyone is different, but I find things like having a spa/steam, getting a massage, going for a walk and reading a book great ways to relax either alone, or with family/friends.

Again, the challenge here is more mental, the feeling of being in a “rush” to get fit.

It’s funny, because usually this rush is felt after years of doing nothing. Hence the appeal of “12 week programs”. A better approach would be a “12 month program”, but often this is felt as being too slow. The same people who feel 12 months is too long will undoubtedly be saying “wow, that year has just flown by” come December.

The simple act of getting healthier will improve your fitness, but trying to get fit when you aren’t healthy won’t improve your health, and can often harm it.

Then Move Well

Movement quality, like health, is often skipped over in the chase for capacity.

Like skipping the “get healthy” stage, skipping movement quality is a recipe for future injury.

The problem is, movement quality is hard to measure.

Doctors will be able to tell you whether you are healthy enough to exercise with intensity, they won’t be able to tell you if you are ready for a loaded squat or running.

There is no one way to move well, but there are common features on moving well. Think of watching a high level dancer. It likes smooth, controlled, almost effortless. They are moving well.

Moving well is a lifetime endeavour (are you sensing a theme?), but to start out, you can perform some simple tests to see what your starting point is like.

  • Can you touch your toes?
  • Can you reach over and under your shoulders and touch your fingertips, without straining?
  • Can you squat to below parallel without your heels rising or losing your balance?
  • Can you stand on one leg with your knee lifted above your hip for more than 10 seconds?
  • Can you perform a plank for 30 seconds? What about a push up? What about 5?

Most of these movements are simple, yet involve a lot of physical capability. If you can’t perform them, are you ready to be running for 30 minutes or performing “functional high intensity workouts”?

If you lack some fundamental movement quality, you don’t have to put your fitness on hold – remember, improving your health, in this case your movement quality, will improve your fitness.

Improving your movement quality doesn’t mean you don’t get to use load either. Load can often be corrective.

But it does mean identifying why you aren’t moving well.

If you have a mobility issue, simply adding load won’t resolve it. Likewise, if you aren’t moving well because of impaired sensory function, you will want to address that.

Moving well is a continual process, but after you have established a healthy base, you will likely want to build capacity.

Next, Develop Your Fitness

You need fitness too.

Especially later in life, when having low physical capacity becomes problematic.

The key though, is to build your fitness/capacity before you get older. The earlier you start, the better, but it’s never too late. Never.

How much fitness, or capacity do you need? Enough to do what you need to do, with a little left over.

This left-over is termed the physiological buffer zone (2).

It is basically your margin for error.

The bigger your buffer zone, the more you can do without breaking down, getting injured or ending up in pain.

A favourite study of mine showed that in US Marine recruits, those with low Functional Movement Screen (FMS, a simple screen to assess movement quality) scores and a low 3 mile run time had a much high probability of getting injured during physical training (3).

Both the run and the FMS were predictive, but the combination was much higher.

This suggests that moving well, or being fit alone is beneficial, but moving well *and* being fit has a compounding effect.

High Training Loads Protect Against Injury

Lots of recent research in sports science is showing that high training loads are protective of injury. (4)

This means, the more work you do, the more resilient you become.

However, how you get to those high training loads matters.

If there is a sudden jump in workload, that is a big risk factor for injury, so you have to build up slowly. If you look to fit people for inspiration, and try and model what they are doing, you are failing to take into account that it likely to them years to achieve their current level.

Monitoring your workload is important, so that you can know when to push and when to back off. A good personal trainer or exercise physiologist can help you, and will accelerate your progress.

Conclusions

This is a lifetime process.

If you do it correctly, focusing on health as your priority, then you set yourself up for a lifetime of benefits.

It’s definitely not easy.

You will have periods where you feel like it is all clicking.

You will have periods where it all seems so hard.

But, if you establish healthy habits, then you can continue with the behaviours that benefit you no matter what life throws at you.

 

 

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 


 

 

References

*If you are unable to walk due to disability, then a similar low intensity replacement is ideal, but for able bodied people, walking is the best option.

(1) Australian Daily Steps

(2) Movement Reserve: Enhancing the Physiological Buffer Zone

(3) FMS and Aerobic Fitness Predict Injury

(4) Monitoring Athlete Training Loads: Consensus Statement

(5) Andrew Read and Greg Dea seminar, September 2016: Advanced Program Design

Aging, Fitness and Flexibility

van Damme Volvo Splits

Two of the biggest physical issues we face as we age are:

  1. Loss of strength and power (1,2)
  2. Loss of mobility and flexibility (3)

For most people, exercise is a means to improve and maintain their health and well-being (including aesthetic goals).

So it makes absolute sense to focus on preventing or minimising the loss of these physical qualities as much as possible, in order to maximise health and well-being for as long as possible.

One of the best things about the rise in popularity of Crossfit and functional training is the emphasis on explosive movements to develop power.

However, despite this increased popularity, it is still rare to see people in gyms, fitness groups and sports clubs (martial artists and dancers excepted) doing any dedicated and meaningful flexibility work (a couple of quick toe touches before a workout don’t count).

I think this stems from a few different reasons:

  • Flexibility work is hard to monetise (there is no equipment to sell for example, outside of maybe a mat and a strap).
  • Stretching well takes time – people have been sold on 30 minute fitness, which is great, I love short sessions, but not at the expense of what you need.
  • Most people don’t know how to stretch well, so they don’t feel any lasting benefits from doing it and give up.
  • Misinterpretation of the research surround stretching, especially around pre-exercise stretching and force production which has seen a preference for dynamic mobility over more traditional flexibility work.

Use It Or Lose It

Almost everyone will agree that “prevention is better than cure”, and this is especially true with flexibility training.

Like every physical quality, flexibility exists on a “use it or lose it basis”, so if you live a modern life like I do (lots of sitting, very little physically taxing work outside of exercise), then it is very easy to lose.

To combat this, it is essential to work on your flexibility pro-actively.

Optimal Vs Reality

Understanding what is optimal for physical health and fitness, and what can be realistically achieved by someone for whom fitness is a small component of their life is quite important.

For the person who exercises because they have to in order to maintain their health, but they don’t necessarily derive any pleasure from it, the minimal effective dose for flexibility is all that is needed.

This person can regain flexibility by stretching (4), can then maintain it with almost any activity that requires range of motion – for example, a gym based exercise program or tai chi practice.

Additionally, if they make an effort to squat, bend, reach and generally move more in day to day life, then maintenance is that much easier.

Fitness Enthusiasts

For people who spend a lot of time and energy into improving their physical fitness, a specific focus on stretching will be beneficial.

This can take place as part of the warm up, cool down or separate session, as there a pros and cons to each.

For the fitness enthusiast, recreational or even professional athlete, a prime focus on flexibility and it’s associated qualities – motor control and joint stability – is even more important, due to the high loads placed on the body consistently from training and competition.

I believe that stretching is the only physical quality that in relation to it’s training, the saying ‘more is better applies. – physical preparation coach Ian King, whom I have mentioned on this blog previously. (5)

Again, this is a contentious area, as most research doesn’t show a cause-effect relationship when it comes to stretching and injury prevention, but there are many contributing factors, of which flexibility is just one.

Conclusions

You don’t need to turn yourself into Jean Claude van Damme (pictured above at age 53 in a Volvo commercial), but you do need enough flexibility to reach up overhead comfortably, bend down without strain and essentially move without restriction doing the things you do in your day to day life.

If you don’t lead a physically active life, then it is more important to increase your activity – even if you don’t exercise – than worry about specific stretching.

Once you are active, a focus on stretching can really complement whatever it is you are doing.

 

This post is a re-worked version of my May 2016 newsletter. You can sign up below to receive all future editions, plus my upcoming (and FREE) guide to stretching.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

References

(1) Strength and muscle loss with aging process

(2) Age associated loss of upper extremity strength and power

(3) Flexibility of older adults and the influence of physical activity

(4) Purely my opinion, eccentric exercises can also be very helpful.

(5) King, I., Legacy – Ian King’s training innovations, King Sports International

7 Effective Ways To Avoid Injury Exercising

Group Exercise @ Healthy Fit, Fitzroy North

Supervised group training at Healthy Fit – professional supervision is a great way to reduce injury risk whilst exercising.

There are numerous benefits to exercise, but what’s often not mentioned in all the pro-exercise publicity, is that there are also risks involved, chiefly the risk of injury.

Many people, despite their best intentions to get healthier and feel better, actually end up unhealthier and feeling worse after injuring themselves pursuing their fitness goals.

Recently, I polled my personal Facebook account for stories of injury whilst exercising.

It didn’t take too long for my notifications to start pinging like crazy. Here are some of the responses I got:

went for a 7-8km run then stupidly tried to do a back session whilst fatigued. deadlifting with no energy then gave me a slipped disc and a very shitty year ahead.

it still niggles. its probably at about 85%. back in the gym but i never lift at more than about 60%. also trying footy again this year but am a little worried about getting a big bump. long car trips are also a horrible experience if i dont have a rolled uo towel to place on my lower back.

I was doing weight training and now my knees are stuffed!

Sore left glute early on in hockey season. Hockey is a right handed game (seriously) and a lot of players tend to develop niggles on the left side.

Buggered knee from years of over exertion bad form and bad knees

Yes many times mainly due to my strength being far superior than my mobility and flexibility at the particular time.

High volume squats. Poor form with my wrist. – sprain which eventually led to avascular necrosis of the lunate.
Heavy tb deadlift pb. Not enough food tat day and lifted too heavy given a lack of conditioning (hadn’t lifted heavy in 3 months) back injury – 6 months.

Back is fully recovered, wrist is permanently injured.

 

Not all injuries are created equally, however, and there were many stories involving accidents and trauma which I haven’t shared. Whilst little can be done to eliminate accidents, setting yourself up to exercise as safely as possible can greatly reduce your risk of injuries like the ones described above.

In my years of practice, and especially now being an osteopath based in a gym, along with almost a decade of personal training experience , I’ve learnt a few things about why people get injured exercising. A lot of the time, there is the perfect storm of preventable factors that combine to result in injury.

With that in mind, I’ve listed 7 ways to prevent injuries whilst exercising:

 

1. Make sure you want to exercise in the first place

Most people don’t think things through properly before they start.

When it comes to exercise, before you start, you have to know why.

Without a good reason to exercise, you won’t put in the effort to do things properly, which is a sure-fire route to getting injured, or you will, but the effort will be such a stress that it negatively impacts other aspects of your life.

Deciding to exercise will either have a positive or negative motivation behind it.

Positive: I want to be healthy and feel strong so that I can live a full life.

Negative: I don’t want to end up weak and frail and isolated in a nursing home.

Neither is right or wrong, but from experience, negative motivation only lasts so long. If it gets you going, great, but be aware that those that stick to exercise for life tend to have positive motivations for doing so. Don’t worry though, chances are you’re reasons for starting will be different to your reasons for sicking to it.

Exercise is fantastic, most people should be engaging in some form, but it is not essential to exercise to be healthy.

So if you chose to do so, know your reasons.

 

2. Learn to move well

This was almost going to be number 1, because, even if you don’t “exercise”, chances are you move.

Learning to move well is both simple and complex at the same time.

The knowledge behind the process is actually quite complex, but what you have to do is relatively simple. The key is to seek out an expert who has the complex knowledge but can provide you with simple, actionable steps to get you to move well.

Whether it’s an osteopath, a personal trainer or both, the initial investment in learning to move well will pay you dividends for life.

 

3. Know your weaknesses (and address them)

We all have strengths and weaknesses. Naturally, we gravitate towards our strengths.

Big strong people tend to like to lift heavy things. Tall and lean people tend to like to run, row or ride.

Of course, these are just generalisations, but the point is, if we only ever focus on our strengths, chances are we will limit our potential achievements and increase our risk of injury, as our bodies become ever more efficient at compensating until they can no longer.

Identifying your weaknesses is a tough thing to do. Most of us a terrible at looking at ourselves objectively. This is where it pays to hire a professional to tell you what you need to work on.

Not only will address your weaknesses make you more resilient, but your biggest fitness gains will come from improving your limiting factors.

 

4. Progress intelligently

One of the biggest predictors of injury is the ratio of acute to chronic training volume.

What the heck does that mean?

It means when you see a big increase in the amount of work done in the short term, relative to the amount of work done in the long term, then injury is more likely.

Put another way, you have to build up your tolerance to large training loads.

That means starting well within your capabilities and progressing gradually.

The 10% rule – not increasing total training volume by more than 10% per week – is a good general guideline to go by.

Start with an assessment to work out your current abilities, and then progress gradually, using different means of progression. Intensity, volume, frequency, rest, density and even activity/exercise selection are all variables that can be manipulated to provide progressions.

You should have certain indicators that help you identify when you are ready to progress – whether they are qualitative (rating of perceived exertion (RPE) scales) or quantitative (biofeedback like heart rate or power output). (1)

This will prevent your ego getting in the way and causing you to make to big of a jump too soon, which is a massive cause of injury.

 

5. Prioritise recovery

Everyone loves to train hard, not many people like to put in the effort to recover well. However, your ability to exercise is determined by your ability to recover.

Recovering means more than time off training. It means actively taking steps to relax and regenerate both your body and mind.

That means your nutrition and sleep must be on point, but also, your workload and personal life must be taken into consideration of your exercise load.

There are a few ways you can monitor you recovery.

Old school: keep a journal, track your mood and a RPE for each session. If your RPE is going up and your mood is going down, it’s a good sign you’re not recovering enough.

New school: Heart rate variability (HRV) apps. HRV is a way to measure your autonomic nervous system activity, which is a good marker of how stressed you are. You can download various free apps which will sync up with a chest heart rate monitor, whilst at least one can use your smart phone’s camera to measure your heart rate via your finger tip.

Recommended HRV apps*: EliteHRV,  ithlete, HRV4training (iPhone only) (2)

The best approach, which is also the most effort, is to combine a journal, RPE scale and HRV data. Initially, it won’t tell you much, but over a longer period of time, you’ll gain valuable insight to your physical and mental state, which will allow you to know when to push hard and when to back off.

Even if you don’t monitor your recovery status, simply allocating time for active recovery techniques is doing better than 95% of people.

 

6. Balance your training over time

Depending on your individual goals and personal characteristics, you will train in a way which builds particular physical qualities.

However, it is important for health and longevity to build all physical qualities to some degree – flexibility, mobility, power, strength and endurance.

Even if you are a highly specialised athlete, outside of your sport, all training is general in nature, and thus you should aim to improve a range of general physical qualities to minimise injury and maximise performance. If your sport is “the game of life”, then this only adds to the need to exercise a broad range of attributes.

Balance is more than being well rounded; you want balance between periods of hard training and periods of consolidation, which goes back to prioritising recovery.

 

7. Don’t chase fatigue

Anyone can make you TIRED. It takes a skilled professional to make you BETTER.

One of the biggest mistakes people make when exercising, whatever their motivation for doing so, is “chasing fatigue”.

This is a problem, because whilst how we feel on any given day is important, it gives us no insight into whether we are actually improving.

Additionally, chasing fatigue often results in compromising your movement in order to complete a given task, which is risky business to say the least.

This occurs because people associate with certain feelings, and a common association, often perpetuated by the mainstream media is that a workout has to be hard to be effective.

Now, of course, some exercise sessions will be tiring, that’s completely okay, but fatigue should be a by product of exercise, not a goal in and of itself.

You don’t always have to improve from session to session, or even in a straight line (pro tip: neither happen in the real world anyway), but, over a long enough period of time, you should improve at what you are doing.

The best way to know this is to keep a training journal, but if that’s too tedious, having “milestones” throughout the year where you test yourself are a good way to keep track on a macro scale.

8. (BONUS) Fit the exercise to your body, not your body to the exercise

Not everyone is built to run long distances or squat heavy weights with a barbell.

This goes back to knowing your weaknesses (and strengths), but you should choose activities and techniques that suit your body type and abilities.

If you like to run, that’s fine, but maybe marathons on roads don’t agree with your body, so instead, you try shorter distances or trail running.

Likewise, if the gym is your thing, build your program around exercises that suit your body, not what some article online says is the best “butt builder”.

Final Thoughts

Injuries can still happen, despite your best intentions, but there are lots of things you can do to minimise your risk, the above list covers 7 very important elements to consider.

A lot of them have overlap – doing too much too soon and not getting enough rest – and are generally brought about by not knowing any better (forgiveable) or getting emotional/letting your ego guide your decisions (not-so forgiveable).

Exercising should be enjoyable, not a chore, and this list isn’t meant to take the fun out of exercise, but rather, help keep you injury free so that you can continue to exercise in a way that you enjoy.

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



Notes

(1) To read about a simple, easy to use RPE scale, as used by the Australian Institute of Sport, read this.

(2) I’ve only used EliteHRV, but the other two come highly recommended from other professionals I trust.