What is it? – Spondylolisthesis

Spondylolisthesis: when one vertebrae slips forward on the vertebrae below it.

There are two types of spondylolisthesis, generally seen in two different groups of people. Isthmic spondylolisthesis occurs mostly in young adults, with symptoms initially appearing between ages ten- and fifteen-years-old. This type is especially prevalent in those who are involved in sports that include a great deal of jarring movements and hyperextension through the lower back, such as gymnastics.

On the other hand, degenerative spondylolisthesis is not usually seen in people younger than forty, becomes more common with greater age, and is three times more common in women than men. Both types are associated with degeneration of the intervertebral disc, arthritis in the joints between the vertebrae, and weakening of the muscles supporting the spine. Exaggerated extension of the lower back will also lead to some muscles in the lower torso and pelvis becoming short and tight, and others long and weak.

Lower back pain is not always a symptom of a spondylolisthesis, though it can certainly be present, especially when bending backwards or with long periods of standing. Symptoms in one or both legs are common, including pain and cramping. Due to possible pressure on the nerves stemming from the slipped vertebrae, weakness, numbness, and tingling in the leg or legs may also be felt. Any concerns should be addressed with a doctor, chiropractor, osteopath, or physical therapist, who can confirm the diagnosis and start you on the appropriate treatment.

So, if you are diagnosed, what then? In addition to rest and any prescribed anti-inflammatory medication, both appropriate exercise and remedial massage therapy can play a significant role in the treatment of spondylolisthesis. Ligament laxity and weakening of the tiny muscles around the vertebra are often found in spondylolisthesis patients, so it’s in your best interest to build stability and strength around the spine. Emphasis should be on torso-strengthening isometric exercises (those that are done in stationary positions, like planks), single-leg exercises that allow you to maintain a neutral spine and pelvis, and any exercises that will avoid hyperextension of the lower back. Reducing tension in the short, tight muscles (hip flexors at the front of the pelvis, and the erector spinae group and quadratus lumborum at the lower back) can help decrease lower back stress associated with hyperextension, and will support any manual treatment provided by a chiropractor, osteopath, or physical therapist.

Remember that your exercise program should always take into account all of your goals and needs, not just addressing one specific diagnosis. As always, both exercise guidance and massage therapy should be provided by qualified professionals working in conjunction with your medical team. For best results, get your doc, physical therapist, and personal trainer or exercise coach talking – plus your chiropractor and massage therapist, if you see these. There are several great therapists in the Alexandria area (and the rest of Northern Virginia), so please ask for a recommendation if needed.

Five tips for creating good habits

Just like anyone else, I sometimes fall into habits that aren’t the best for me. And like most other people, I am fully aware of the fact that what I’m doing (or not doing) may not be in the best interest of my health and fitness. Habits, however, are pretty much by definition subconscious – we are making these choices before we can even realize we are thinking about them. So, how does one go about giving the bad habits the flick? I’d like to share some strategies that have worked for me and my clients in creating sustainable exercise and nutrition habits:

One thing at a time: Old habits are hard to change, and new habits can be difficult to create. According to author Leo Babauta in his book The Power of Less, when adopting a single new habit over the course of a month, success rates can be as high as 80%. Unfortunately, many people I’ve spoken to have an impression that in order to have a healthy lifestyle, they will have to completely change everything in their normal routine right now – somewhat of an all-or-nothing approach. Some people are successful in creating multiple new habits simultaneously, however for most of us, trying for more than one change at a time can decrease our success rate to below 20%.

Take your time. It can take up to a month for a single new behavior or choice to become habit. This is because the neural pathways that lead us to complete a habitual behavior are etched into our brain, triggered automatically in particular situations. New pathways can be created, but (as we know) to get started takes a conscious effort. The conscious effort is the creation of the new neural pathway. Allow yourself a month to form the new pathway and for repetition of your new habit to grease the neural groove. Bonus point: write down your new habit, what your “trigger”  or prompt for the habit will be, when you will do it, becoming your daily checklist.

Set yourself up for success. Since you’ll have the most success with adopting a single new habit at a time, make it a good one. Pick one that is important to you; you are much less likely to abandon a new behavior that you believe will create a positive change in your life. In addition, this can help provide the “reward” that feeds the subconscious habit loop. We all like to be successful and feel good, so create this situation for yourself. Remember, too, that success breeds success: You’ll feel better with every day that you successfully complete your new habit. This can help you make better choices in the interim, and may allow you to start on the next new habit sooner – as long as you can truthfully tell yourself that the first habit is set in stone.

Get some cheerleaders. Enlisting support can provide encouragement and accountability. Tell your friends, family, co-workers, and everyone else you know about your new habit. Ask them to ask you how it’s going, or to remind you if they see you slipping into old habits that you want to get away from. Keep them posted on your progress as often as you can. If you are working with a personal trainer or exercise coach, this should be a huge part of their role in being there for you (I try to keep tabs on my clients even when I’m not seeing them for a few weeks). Being your own cheerleader is also important. It may sound corny, but I’ve had a lot of success personally, by telling myself that I AM going to do my new behavior, and when I do it, it will be good for me and I will feel better – either physically, or mentally because I know I’ve met my goal for the day. I also have known people to put signs up around the house to remind them of their desired change, or the outcome of the new behavior, or to create a trigger for their new habit (I used to forget my lunch at home all the time, then I figured out if I put my car keys on top of my lunch in the fridge, I would never forget my lunch again).

Get back on the wagon. Very few people adopt a new habit without any set-backs. If you miss your new habit for a day, don’t sweat it too much. Beating yourself up will not make up for a miss. A better approach: Give yourself a fresh start from that point on. As the Chinese proverb goes: The best time to plant a tree was 20 years ago. The second best time is now.

Functional Movement Screen

As an exercise physiologist, personal trainer, and general fitness enthusiast, I’ve always been a big believer in developing strong foundations prior to lifting (or running, or tennis, or anything else). Within my experience, poor foundations equals movement dysfunction equals poor performance and pain – if not now, then definitely down the track. If we aren’t in pain, we generally don’t think twice about our foundational movement quality. Why would you, if you feel good and can just go lift weights, or play tennis, or ride your bike? No matter what you do though (even if it’s not a sport, and you just want to live your life without pain) good movement is key.

The way your body is programmed to move – called movement patterns – plays a large part in your likelihood of getting injured, and how well we are able to complete our daily activities and play our sports. The Functional Movement Screen (FMS) is a great way to keep an eye on the quality of your foundational movement patterns. The screen itself is simple, yet thorough. You complete seven different movement patterns to the best of your ability, and I look at how you move as a whole, without over analyzing things or making you try it again and again. In less than 15 minutes, we have a roadmap highlighting what your body needs to be fully functional and what path will take us there. The process is relatively simple – find the worst pattern, and work to bring it up to speed through corrective exercise. No need to focus on strengthening a specific muscle, or identifying the biomechanical weakness – just work on making the movement better.

The FMS was created by a couple of very smart physical therapists as a tool to help define movement quality by taking a patient or client through a series of foundational movement tests (this is me paraphrasing, by the way). These particular movements are included because they form the base of all of our other movement, whether exercise-related or simply performed as a part of daily life. The idea that fixing the basics of movement and addressing the causes of pain, rather than simply working on the painful area in an attempt to improve function and performance makes sense. The screen is increasing in popularity as more trainers are exposed to it, perhaps in part as it has been embraced by numerous professional and collegiate sporting teams and the United States government and military. This bodes well for the state of the industry in general and for anyone looking to start or update an exercise program the right way. To find a FMS practitioner in your area, you can find a Certified Member here at the official FMS website. I highly recommend it!

If you are interested in having your own FMS done to kick start your exercise program or to breathe new life into your workouts, and are in the areas of Alexandria, Arlington, or Fairfax county, Virginia, please get in touch!

This article is has also been published at our sister site, Fix Fitness & Bodywork – Alexandria’s premier in-home personal training and massage providers. Visit us there if you want to exercise the sustainable way!

Client Assessment: Finding Your Starting Point

“If you don’t know where you are headed, you’ll probably end up someplace else.” – Douglas J. Eder, Ph.D

This is true about pretty much everything in life – I’ve been on paths with known and unknown destinations, which has certainly made life interesting.

Exercise is no exception to this rule. I’ve never met a client who didn’t have a reason for wanting to start an exercise program. This is a good thing – goals provide motivation and help determine what your program should look like. But there is a lot more to creating even a simple exercise program than simply knowing what you wish to achieve from it.

KNOW YOUR STARTING POINT

The first meeting every client should have with their personal trainer, strength coach, or even physical therapist should be an assessment session. I know this strikes dread into the heart of many, however the word “assessment” doesn’t mean that you are going to have to stand on the scale, have pictures taken wearing a swimsuit, or run on a treadmill until you collapse. Some of these may be helpful, depending on your goal, but the majority of my initial meetings with clients are much less complicated. New clients are asked to fill out a questionnaire describing their lifestyle, exercise, injury, and pertinent medical history, goals, and exercise preferences. I always take the time to review the forms with each client, making sure we are both on the same page and moving forward together. There is also (most often) a movement component to the session. While movement assessment can take many forms, my preferred is the Functional Movement Screen (FMS). Simple yet thorough, the screen gives us a baseline for movement abilities, providing insight into potential injury risks and guidelines for exercise selection.

KNOW WHERE YOU’RE HEADED

Goals, lifestyle and personal history, and current movement abilities provide the framework for the exercise program. Once the starting point is known, the exercise program can be designed to specifically address your needs. This also takes into consideration likes and dislikes, and what of the million exercise options seems to be working the best. The more information we have at the get-go, the better prepared we can be (read: your program will work better for you).

KNOW WHERE YOU’LL END UP

Assessment also provides a framework for reassessment – knowing where you’ve ended up. Even if you know you haven’t reached your end goal, periodic reassessment is important to make sure everything stays on track. While the intangibles of the assessment – lifestyle, goals, exercise preferences and the like – are often discussed informally during sessions, it’s sometimes difficult to keep tabs on the progress of movement abilities. The FMS makes this easier, allowing objective re-assessment, which keeps the program on track. Even between reassessments we have the opportunity to tweak it as needed to make sure we are always headed towards the primary goal in the most efficient way possible. And, more importantly, that you are comfortable and confident in getting there.

If you are interested in an assessment session to kick start your exercise program or you want to breathe new life into your workouts, and are in the areas of Alexandria, Arlington, or Fairfax county, Virginia, please get in touch!

 

This article is has also been published at our sister site, Fix Fitness & Bodywork – Alexandria’s premier in-home personal training and massage providers. Visit us there if you want to exercise the sustainable way!

What is Exercise Physiology?

Telling people I am an exercise physiologist has almost always resulted in some quizzical looks – most people have no idea that this subsection of the health and fitness industries exists. Even those who have heard of the profession before may not have a clear understanding of what an exercise physiologist (EP) actually does. Earning the accreditation opens doors to many occupations, from clinical exercise stress testing in hospitals, to coaching elite athletes in a role perhaps better known as strength and conditioning, to taking on a role similar to that of a personal trainer in a gym or private training studio. To gain accreditation, an EP must complete a minimum of a bachelor’s degree in an exercise or physiology related major (this varies based on the requirements of the certifying professional organization). They will be well versed in how the body reacts to exercise in the short term and adapts over the long term, how exercise can be used as a tool in injury rehabilitation or to improve or slow the progression of chronic diseases and conditions, and how to include exercise in your lifestyle to support general health and fitness.

While an EP has the option to work in a wide variety of settings, many choose to focus on a specific client group or area of expertise. I predominantly work with clients who are new to exercise, particularly those with poor movement abilities, past or current injuries, or those dealing with a chronic disease or condition. When necessary for client benefit, I work in conjunction with doctors, physical therapists, or other health professionals like chiropractors or massage therapists to provide a truly comprehensive and individualized program, and therefore provide the best possible outcome.

Working together starts with an appropriate and thorough assessment, including movement screening and discussing pertinent medical, injury, and lifestyle history. This information is used to create an exercise and lifestyle program to guide each individual through the activities that will most benefit them. This can include working out at home, in their local gym, or out and about along the trails and in the parks of Northern Virginia and Washington DC. My role allows me to help each client through their program, making sure that they are confident in their abilities, comfortable with the program, and still challenged enough to continue to progress towards their goals. I am also there to troubleshoot – when things aren’t working as planned, we find another way to achieve the same end. Though sometimes this is a slow process, it has invariably been a positive one. The most exciting thing is when people realize that they actually CAN feel better – doesn’t everyone want that?