The Back - level one

Back Strengthening Exercises - first level Back Stretches Garrick starts with stretching the back. From what I've seen of most people my age, be they male or female, that's going to be essential. Quite a few people are hobbling around, even though they're not over sixty, with a curled spine and legs that don't move much. This is horrible. But then, I've also met twelve-year-olds who cannot touch their toes, and it makes me a little ill to think how life is going to be for them when they're sixty. Crippled, I daresay, and dependent on a walker or a wheel chair. Bonnie Prudden has an interesting story of her involvement with a wheelchair patient. I'll put it up some time soon, probably right after I get done with this introduction section. Lie on your back. Grasp the back of one thigh and gently pull your leg to your chest. If you can't do that, just pull it toward your chest till it stops. That's what the "gently" means. Hold this stretch for fifteen seconds. if it starts hurting before fifteen seconds you've pulled it too aggressively and let go of it. Next time ease up. This is a stretch, not a rip. Anyway, at fifteen seconds lower the leg to where it was and gently pull up the other one. Hold, put it back. Now do both together. You know what to do if it's difficult--just do the best you can. Everything will improve with time. Relax, put your legs back, and go on to curl-ups. After your curl-ups, finish with some nice, relaxing repeats of the back stretches. Curl-Ups Curl-ups are mostly to strengthen your abdominal muscles, but those are very important toward supporting your back. Also, they don't do a lot to stress your back unless you stop paying attention to what you're doing and allow your back to arch. So don't do that. I don't think these are enough level one exercises. I went to other books and found the following. Shoulder blade squeezes Stand up straight. (I sit in a certain chair because of the feedback I get from it as my shoulder blades press against the back.) Shoulders back. Suck in gut while doing this. Now use the shoulder muscles to press the shoulder blades toward each other. Hold this contraction for three seconds (eventually increasing to six or ten), then release. Relax for three seconds. Start out with four contractions, twice a day, increase to twenty contractions five or ten times a day. Do not work to the point of strain or pain. Daily Challenge gives us a few exercises: Alternating stretches Kneel on all fours on the floor. I can't do anything on the floor till I get a mat so I do it on the bed, which is ugly-hard. Make sure the hands and knees are directly below the shoulders and hips. Slowly raise the right arm and point straight ahead, hold three seconds, replace hand on the floor. Raise the opposite leg (the left one in this case) and extend it straight behind. Hold for three seconds, then replace. Switch and do left arm, then right leg. Over time, increase the number of reps per set and the number of sets per day, while lengthening the amount of time the limbs are held up. Eventually we'll be doing the arm and opposite leg together, but that's a level two thing. Gluteals squeeze Stand up straight, feet hip-width apart. Squeeze the glutes together while also contracting the backs of the thighs. Squeeze for three seconds, relax for three seconds. Repeat for four squeezes, twice a day. A must to avoid: Toe-touching Vigorous hamstring stretching Using excessive weights with any kind of lifting Sit-ups with your feet hooked

To reiterate, I'm not telling anyone to do anything. I'm not a doctor, I'm not a personal trainer. I'm just telling YOU what I'm doing and letting you know what worked and what didn't. I'm an older woman and I want to get fit. More than fit, really; it was my dream (though I never had the time and freedom and information to make it a goal) in college to get physically fit. To me that meant strong, thought not necessarily muscular; I wanted to have the stamina to run to run a fair distance (ten miles, perhaps, but I'd like to run a marathon now). Had I ever had a clue how to get to the point of being able to do one-armed pushups, I would have been in pig heaven. I have the time to do all this now. But at 59 years of age, this isn't exactly a refresher course for me; I'm pretty much starting from scratch with just a few advantages. Staring a fitness program from scratch at my age? I'm determined to make it so. I'm in very bad condition. I used to be fit, and was well able to play tennis like a fiend. That was when I was 19--forty years ago. In my twenties I taught sailing and raced my Hobie 14' catamaran. I won almost all the time. It takes a few muscles to do that kind of racing. I was fit for it. But, since college and through the last thirty years, I haven't had much opportunity to do much. I'm more of a reader and a watcher of movies than I am a gymnast or jogger. I've been sedentary

The Back

Doctors often prescribe fitness-enhancing exercises to treat or relieve back pain. You may be doing your back a favor by working your body into shape. So hurray! I've been working on my other areas to get rid of some pain I've had. Now it's time to add back exercises, because I can tell you, I've had a lot of back pain through my life. I'd like to get rid of it. Through my life, since I severely injured my back, I must have been favoring my back. I didn't know it till I started all this exercising and managed to drive away a lot of my pain through strengthening the joints. Now I will try to use what I've learned to do my back some favors--strengthening the back and strengthening my abdominal muscles together to make it possible for me to stand up straighter and quit stressing both my lower and upper back. Back Self-Examination Do you have pain radiating down either or both legs? Do you get back pain or radiating pain when you cough, sneeze, or strain, such as when moving your bowels? Do you have weakness in your legs, such as the inability to stand on your toes? Do you have any numbness or tingling in your legs or feet? Have you ever been diagnosed as having disk disease or a ruptured disk? Have you ever been told your back x-rays are abnormal? Have you had any episodes of significant back pain or other back problems within the last twelve months? If you answered "yes" to ANY of these questions, go to a doctor right away because you may be experiencing clues to serious back problems. If the answer to all of these questions is "no" then answer these questions: Is your back stiff when you get up in the morning? Does your back ache after you've been sitting or standing for more than thirty minutes? Does your back ache the day after any unaccustomed activity such as skiing or or tennis? If the answer to any of these questions is yes, then you should talk to your doctor about beginning a back exercise program before going on to a general fitness program. If the answer to all of these questions is "no", then most likely your back is in fair shape. But to be sure, go on to this next part of the examination. Sit on the floor with your legs extended in front of you. Now lean forward with your arms stretched toward your toes. Can you comfortably reach your fingertips beyond your kneecaps? Lie on your stomach. Are you able to arch your chest and legs upward at the same time painlessly? When standing, are you able to move your back in all six directions--front, back, left, right, twist to the left, and twist to the right? Can you do so comfortably? Are you able to do five curl-ups? How to do curl-ups: Lie on your back, knees bent, and your hands placed far up your chest. (I crossed my forearms and gripped my shoulders and unknowingly pulled my shoulders, causing strain on the sore shoulder, so beware of something like that.) Some manuals say not to roll your head and neck forward but they don't say why. I gave myself a headache till I read someone's advice to hold the head and neck out straight from the shoulders without curving them, so now I don't get neck aches from this and I'm sure I'm doing them right. Also, make darned sure you're not arching your back, which pulls the psoas into action and can give you a very sore lower back. Curl up slowly till the shoulders and then the upper back come up off the mat, then stop there. Hold that position for the count of three, then curl down slowly--again, without arching the back. Breathe normally as you can. Do five of these. I've already added twisted-curl-ups, and do four (left, center, right, center) with three seconds' breather after each curl-up, and do six of these to get twenty-four curl-ups. I doubt I'll have Stephen Amell's sixpacks >-) any time soon but it will be nice to be able to suck in my gut and have it stay sucked in.

Shoulder Strengthening Program - second level

Second Level -- Adding resistance. Bend over at the waist and with your arm pull back against the resistance without bending your elbos, as though you were sawing something you had placed on the floor straight below your shoulder. Ten pull per set, a couple of times per day. As you grow stronger, increase the resistance by stretching the tubing farther so that it's harder to pull. This exercise strengthens the rhomboids and middle trapezius, the muscles in your upper back that control the movement of your shoulder blades. To strengthen the deltoid muscle on top of the shoulder, stand with your arms at your sides, your left side aimed to the wall, your right side aimed away from the wall. Grasp the band with your right hand, hang your right hand straight down next to your side. Now lift slowly straight out from your side, as if you were about to do an arm swing, but go only as far as is comfortable and no higher. As you grow stronger you'll be able to lift higher. Then increase the resistance. Do two sets of ten reps every day. Exercises to avoid: Weight lifting utilizing the arms or shoulders Rowing machines Nordic track or Nordic trainer Push-ups Pull-ups or chin-ups Games that particularly utilize the shoulder, such as polo, tennis, softball, and golf

Shoulder Strengthening Program - first level

These exercises move your shoulder through its entire range of motion and exercise virtually all of the muscles in the shoulder. As Garrick recommends, I do them in the gentlest way--no weights, no resistance. A week of the exercises did my shoulder huge favors. After just ten days I could lift my bad arm through all directions, and only in a couple of them did I feel anything like pain. Now, after three weeks, it's almost completely without that pain. I do all these exercises still, and don't push anything. I do them through the range of motion that is comfortable. If I get a twinge, I cut down on the range and the effort. I started by doing 20 reps for each of them, twice a day. These were so successful for me that within a couple of days I increased both reps and sets, so I was doing thirty to fifty reps each, four to eight times away. Garrick reminds us to progress slowly and take it easy, that it's more important to progress well, and not to worry about progressing quickly. Circles Bend over at the waist and let the arm on your bad shoulder hang free in front of you. Move your torso so that the arm starts to swing in a circle in a clockwise direction. Use just enough muscle to kick the arm into motion and keep it swinging lazily. If it hurts to make a circle, make an egg shape or any other figure that feels comfortable. Do 20 circles in the clockwise direction, then twenty counterclockwise. Change arms and do the same. The more you do, the more your range of motion will increase. Shrugs Stand or sit up straight. Shrug your shoulders. Gently and slowly. When you've progressed enough that this motion doesn't hurt, vary the path of the shrug. That means do a forward circle, or a backward circle, or a figure eight if you think getting fancy is a fun and safe idea. Sawing Stand up straight, hands at sides. Reach forward as far as your comfortable range will allow, then pretend you are at one end of a two-handled saw, and draw your hand and elbow back as far as your range of comfort will allow, but in the beginning do it without tensing or pretending to pull heavy weight. I found this excellent just for loosening up that twenty-year hurt shoulder. I did it gently when the shoulder was sore and after about three weeks the soreness has almost completely left. I started with ten reps each arm, and did these several times a day. Obviously I wasn't as sore as you might be. Swings I hated this exercise because it demanded I do arm lifts right through the place where my arm shoulder hurt the most, so I modified it to place less streaa on my shoulder in the beginning. Stand up straight, arms down at your sides. Lift them straight out to the sides and up till they meet at the center over your head, then lower them. Do this slowly so you don't jerk your shoulder. These are called "Abduction Swings". Actually at the beginning you raise your arms to a comfortable level only. Even so, this hurt my right shoulder terribly. I figured out that the arm, extended out to its full length, hurt too much to do these so I decided to make my arm weigh less--I flexed the elbow and brought half the weight of my right arm in to my body. It was then pretty easy to raise my right "wing" to almost horizontal. From there I slowly progressed to horizontal, with my arm halfway open (that is, the right elbow bent to a ninety-degree angle) and slowly gained more height from there. I'll be working on opening my arm all the way out. I can do that much now, but it's uncomfortable and I'm not eager to push it. Slow but steady wins the race and doesn't send me back to an arm sling.

The Shoulder

This one was the area I eagerly jumped to, after the section on the knee. Twenty years ago I got a pain in my shoulder. I attributed it to excessive use of the mouse, which I was probably clutching wrong, or so I assumed. Also my desk was way too high, being a desk that was originally a table. In fact the desk I'm working on right now is a dining table and it's several inches too high. Now, the sharp pain that went over the top of my shoulder didn't keep me from doing whatever else I needed to do. The worst one, though, was hefting a forty-pound saddle onto the back of a medium-sized horse. That one hurt like heck. So for a long time I knew that I had at least a tired muscle that hurt a lot, and wondered if maybe I hadn't torn it somehow without knowing it. But I really thought it was just sore. Anyway, I worked around it, tried hard to give it a rest, tried not to over-use it, I even favored it, hoping that I could rest it enough for it to get well. No such luck. Now along comes this book, and its entry-level exercises. I start doing them and lo and behold, the sore shoulder is ten times better in just a week. Not perfect, but I can move my shoulders now without all that pain. Yes, it's not all done yet; I can still feel it in certain positions but it's very mild compared to the last 20 years. The shoulder is the most flexible joint in the body, allowing movement in a large range; but it's also not well supported by a tough joint arrangement, such as is found in the hip where a ball is held in a socket by strong tendons attached to strong muscles. Thus, a healthy shoulder is one with strong muscles and tendons. But I wasn't going to dig right in with some wonderfully strengthening exercises. I've been doing baby pushups for months and working through the pain. I even had some improvement, having gone from 10 pushups to 18 pushups (thanks to the Marine 3x Workout Manual) but since I had started with a bad shoulder, I continued making that shoulder worse. Shoulder Examination First take a quick medical history: Does your shoulder feel unstable, dislocate, or slip out of position? Does your shoulder catch or lock? Do you feel any numbness, tingling, or weakness in your arm or hand? If you said yes, to any of these, go to a doctor. If you said no to all of these, go on to the next level. Does your shoulder feel stiff or achy following unaccustomed or strenuous activities? Do you avoid using your shoulder for certain activities such as carrying suitcase? If you answered "yes" to either question then you need to work on strengthening your shoulder. If you answered "no" to both questions, you may be in pretty good shape, but before you begin any exercise program you should still probably strengthen your shoulders. You don't want to go ahead and assume that because it doesn't hurt, it's good to go, and end up doing to your shoulder what I did to my knees, which is possible. So next comes the diagnosis in the mirror: Stand facing a mirror with your arms hanging at your sides. Are your arms hanging at your side? Are your shoulders the same height? Do they appear about the same size? Looking in a mirror, raise your arms with your thumbs pointing upward. Bring them up to the horizontal and stop. Are the muscles in the front of the tops of your shoulders, the anterior deltoids, the same size? Looking in a mirror, raise your arms out from the sides of your body. Do the tops of your shoulders stay at an equal level as you raise your arms? Or does one shoulder elevate sooner than the other? While standing, raise your arms from your sides and attempt to touch your hands above your head. Are you able to raise both arms above your head to the same degree? Standing with your arms at your sides, bend your elbows and put your hands behind your back. Are you able to move both hands an equal distance up your back? Lie on your back with your arms straight out from your sides and your elbows bent at a right angle. Now allow your hands to droop down to the floor. Do the backs of both hands touch the floor? If not, do both hands come to within an equal distance of the floor? If you answered "no" to any of these questions, one of your shoulders is probably weaker and less flexible than the other. In that case, you should strengthen that bad shoulder before undertaking any general fitness or exercise program involving your shoulders.

Ankle Strengthening Program - second level

These are harder than the little stretchy band resistance exercises because these use your weight to build muscle. Make sure you're fine with the resistance exercises first. Ankle Balancing Without hanging on to anything for support, balance for as long as possible on the toes of your bad foot. Do this exercise frequently during hte day--while talking on the telephone, waiting for a bus, doing dishes, etc. See what I mean? I'll need to be pretty toned up just to do this baby step. Toe Raises This doesn't mean standing on your heels and raising your toes. It means planting your toes and lifting your heels off the ground, and thus raising your entire body. Tough job if you're eighty and have been using a walker for the last year. I'm doing okay with this one. Garrick offers us these two bits of information: 1. Do them with the knees straight and strengthen the muscles in the upper calf, and 2. Do them with the knees slightly bent and you strengthen the muscles in the lower calf. So I'm doing ten of each. He says to do them slowly, every day, and in sets of at least twenty repetitions, both together to get both legs the same strength. Exercises to avoid: Agility running drills Jumping exercises

Ankle Strengthening Program - first level

Ankles! Ouch! Well, mine went owie a few timds. Once in elementary school I was running across a lawn which had sprinkler holes for the sprinklers to retract into, I stepped into one of the holes and twisted my ankle badly enough that I couldn't walk for a week. Swelling, some bruising, I stared at it as if the zerz rays from my eyes could make it go down. This means that I might have needed some rehabilitation now, fifty years later. In fact, I got away with it, because of John Robert Powers, bless their hearts. See, it happens that when I was 11 my mother decided I needed some self-confidence lessons. She sent me off to a modeling school named John Robert Powers. Back then, they were famous. I've even heard them mentioned in an old movie. She talked my way into a class for thirteen year olds--I'm not sure how, unless it was because I was in 8th grade and thus all the other girls I had to associate with were 13. Part of the modeling shtick is to keep yourself skinny as you can, but you also need to walk confidently on absurdly high shoes. Thus, you need strong, slender ankles. They taught us an exercise I've done all my life, partly because it feels good, partly because I didn't want to get thick ankles, and mostly because I never wanted my ankles to get weak, in spite of the fact that I don't wear high heels. I'm a tom boy, which my mother didn't take into consideration. I wear pants and shirts, I used to sew my own dresses and I always altered the patterns to suit me. Sometimes I'd slash a pattern in half, diagonally, and make it up in two different colors, just because the pattern didn't look like that. Anyway, here is this wonderful exercise: Sit. Stick your foot out. Just one foot. I cross my legs so the one foot is up in the air. Start writing the alphabet in the air with your toes. The cursive alphabet: lots of loops and curlicues in it. Try to make the biggest loops you can, without going to such extremes that you have to move your leg too. I always feel the reach and the stretch by the time I get done, so that tells me that if you haven't been working your ankles all your life, you'll probably need to ease into this one. Use your common sense. With any of these exercises they're meant to start out soft because we're all soft. Then use your own sense to tell you when you can get a little more strenuous with them. It's better to advance too slowly than to push yourself too hard and advance fast into damage. If you're feeling your ankles crackle or pop when you try it, get to a doctor to have you and your ankles checked out. Seriously. Don't overdo this. Don't overwork anything. We're just starting out and there are probably years of neglect needing to be remedied all around. Some other level 1 exercises. These are against resistance, so be careful. Get yourself some surgical tubing, or inner tube, or Thera-Band, or what Bonnie Prudden used to call "Stretchy Bands". http://www.amazon.com/DYNA-BAND-Green-Medium-Resistance-Band/dp/B000NCW8T6 In my case, I'm using a nylon stocking with a loop tied in one end, and the other end tied to the leg of the chair I'm sitting in. I'm thinking another option is just to push against non-adjustable resistance, like the side of an upholstered chair or the front of a sofa. I'm doing mine without the purchased stuff. I'm pressing the two feet against each other and using both feet simultaneously as the resistance. There are more complicated flexes, but I can't exactly describe them without pictures. Those will wait for later.

The Ankle

If you've ever sprained an ankle way back in your past, you could have a problem. This is the most common sports injury because anything that causes your foot to turn underneath you--stepping in a hole, a leisurely walk after dinner, tripping over a child's toy--can cause a sprained ankle. In the case of a mild sprain, the sprainee could be back to normal in a couple of days. But the sprain that puts you on crutches for a week or two, or requires you to get surgery, can bring problems down the line. And if you want to work on that ankle, you really need to check it and strengthen it before your first mile jogged stresses it to the point of pain and invisible damage. Similarly, the mere act of overworking an ankle that is weaker than you think can really hurt your ankle, just the way I hurt my knees, thinking there was no problem starting a walking program when they hadn't had any real exercise for years. I had been sedentary for years. Not that I did absolutely nothing; I did regular housework, walked the dog, did a little gardening, even launched an exercise program trying to lose some weight. I did pushups and squats several times a day (and, not knowing what I was doing, failed to build up any strength or stamina). Finally I had to start walking every day; the terrain was easy, the surfaces I walked on were paved. My shoes were Air Nike. I should have been fine, but in just three months' time, my knees were in a great deal of pain--because my poor old knees needed less exercise first. Self-Examination Take your own medical history. Do you have sharp, severe ankle pain for no apparent reason? Does your ankle lock or catch, requiring that you move, twist, or jiggle it in order to unlock it? Does your ankle give way or collapse and then become swollen? Is your ankle constantly swollen? Is it swollen now? If you said yes to any of these questions, see a doctor. If all your answer to these questions are "no", go on to the next level. Do you twist or sprain your ankle more often than once a year? Does your ankle feel stiff the morning following unaccustomed exercise? Have you had a significant ankle sprain anytime in the past? Does your ankle feel as if you can't trust it, especially when walking over uneven ground? If your answer to any of these questions is "yes", then it's likely that you need to rehabilitate your ankle. If your answer to all of these questions is "no", go on to the next level of examination. Sit on a chair in front of a mirror with your feet flat on the floor and take a good look at your ankles. Are they both the same size and configuration? or does one appear swollen, lumpy, larger than the other? Turn your back to a full-length mirror where you can see your heels. Rise up on tiptoe and look over your shoulder at your calves. Are the upper portions the same size and configuration? or does one calf appear larger or more defined than the other? Sit with both legs extended in front of you. Now point your toes. Can you point the toes on both feet the same amount? Stand approximately two feet from a wall, facing the wall. Keeping your knees straight, lean forward over your ankles. Can you lean equally far on both ankles or does it hurt one or both of them to lean forward? Stand with your feet parallel. Squat down. Are you able to squat the same distance on both ankles? Can you balance on the toes of one foot without support for twenty seconds? On the other foot too? Are your balance times within five seconds of each other? Can you hop up and down at least ten times on each foot without letting your heel touch the floor? If you answered "yes" to all these questions, then your ankles are in better shape than mine are. If you answered "no" to even one of these questions, or if you notice any marked difference between ankles, then you could be suffering the aftereffects of an old injury. You should not start an exercise program until you are balanced by strengthening your weaker ankle.

Back Strengthening Program - second level

The next level is a variation on the curl-up. Just start the same as you would with a plain curl-up, but in the middle of your trip to sitting up, you stop, rotate your shoulders to one side and continue holding, then release and curl down. Repeat, twisting slightly to the other side. You can add more twist as you get better at this. When you twist to the side, you engage a wider range of stomach muscles. If you're having problems doing the curlup without overarching your back, try just barely lifting your shoulders off the floor. If you can't do that, contract your muscles as if your shoulders had lifted from the floor, even though they haven't. And bending your hips and knees slightly more might help. Remember to keep pressing the small of your back to the floor so you don't arch it.

Back Strengthening Program - first level

Back Stretches Lying on your back, grasp the back of one thigh and gently pull your leg to your chest. Hold this stretch for fifteen seconds, then straighten out that leg and pull the other one to your chest, hold for fifteen seconds. Then pull both to your chest and hold for fifteen. Relax and go on to curl-ups and repeat with the stretches afterward. Curl-Ups Don't say "I'm going to do the harder ones, real situps" because all the experts don't like situps any more. When you do curl-ups you put your energy into strengthening your stomach muscles, which is what you want to work on when you're working on your back. The stomach muscles help support your back. They're the back's front stabilizers, and strengthening them strengthens your back. Lie on your back on the floor with your knees bent (not more than 90 degrees, though) and your hands resting together over your chest. Then press the small of your back into the floor nd slowly curl your head and shoulders up, to the point where your shoulder blades are off the floor. Hold the position for a moment and then slowly curl back down. You should feel the contractions in your stomach. It is especially important to do curl-ups slowly. Count slowly to six and you curl up, hold for a count of six, then count slowly to six again as you curl down. Breathe naturally. No holding your breath and then letting out an explosion when you've come all the way back. Do as many as you like, and when you get tired, stop. If your back begins to arch, you're tired, whether you'll admit it or not. Stop. If you get any back pain, stop. Activities to avoid while you're rehabilitating your back: Touching your toes Vigorous hamstring stretching Using excessive weights with any kind of lifting Sit-ups with your feet hooked Keep doing your curl-ups. Garrick told the level 1 section to work it till you can do five well, but he didn't say anything about not doing 20 if you can. I'm not sure whether doing 20 is counter-productive or not. Wouldn't seem like it but you need to decide for yourself.

The Back

Self Examination It's safe to assume your back is giving you trouble because it does in most people anyway. That's the price we pay for standing up on two feet. Therefore, having a crummy back shouldn't necessarily keep you from getting into an exercise program or take part in most sports--unless you fail the first self-exam, of course. Doctors often prescribe conditioning exercises to treat back pain, so you could be doing your back a favor by beginning these mild conditioning exercises. Okay, you probably don't need to be told how important your back is. If it's in bad shape, you know all too well. Mine is killing me most of the time. You can thank poor stomach tone for that. I can remember looking at my profile when I was a very very thin eight year old, and noticing my swayed back and wondering why my tummy hadda stick out like that. If I had known better I'd have been doing many many situps every day (which would have been an improvement but nowadays we do curls and crunches rather than involve the back, which is what situps do, to cure the back). Anyway, bad muscle tone, bad posture. The result, I have a couple of herniated discs in the mid-lumbar region which decide to let a certain nerve pair explode if I move wrong, a very nasty ache in the lower lumbar region, another nasty burn in the thoracic region which sets on fire if I work with my arms out, disqualifying me from doing a desk-type job, and occasionally (especially when I bend down to pick something up) shooting pains down the backs of both legs, a problem often called "sciatica". That's all going to end. The two worst areas of hurt are from an injury I caused myself back when I was 14. I fell down the stairs and landed on my back. The stairs had no carpet on them, just exposed walnut flooring, so when the leading edges of these things came in contact with my back (I was carrying something big and it didn't occur to me to drop it and catch myself before I hit the stairs), everything tore there. The doctor from next door told us that I had torn muscles. I think I tore whatever tissues protected and kept the spinal column in a straight line, allowing the vertebrae twist and move just enough to pinch the nerves. The pains were on both sides until they settled in on the right side only. And they would start up most unexpectedly. I'd be fine for two weeks and then my back would explode in pain that pulsed across from side to side and hurt horribly enough for me to scream for help from my mother downstairs. I was still having these unexplained explosions of pain five years later, and when I took a job at age 26 doing desk work, my arms hovering in the air above piles of paper all day, the pain by the end of the day was so bad I had to go home and lie on a heating pad, which may not have been the best thing to do but it was all I knew. Garrick tells us that the clues that let you know you've got a back problem are: Pain Obvious tingling or numbness in the arms or legs Obvious weakness in the arms or legs Coughing or sneezing causing a sharp pain If you have any of the above, that's a fail for your history. Now if it's just a stiff and sore back because you overdid it in the garden yesterday, the best cure, and the best prevention against future injury, is to increase the strength and flexibility of the muscles in and surrounding your back. Self Examination History: Do you have pain radiating down your leg or legs? Do you have back pain or radiating pain when you cough, sneeze, or strain, such as in moving your bowels? Do you have weakness in your legs, such as the inability to stand on your toes? Any numbness or tingling in your legs or feet? Have you ever been diagnosed as having disk disease or a ruptured disk? Have you ever been told x-rays of your back are abnormal? Have you had more than one episode of significant back pain or other back problems within the last year? If any of these is "yes", get yourself to a doctor. Any of these could be a tip-off to a larger problem. If all of them is "no" then go on to level 2: Is your back stiff when you get up in the morning? Does your back ache after you've been sitting or standing for more than thirty minutes? Does your back ache after you do some unaccustomed activity--skiing or tennis, for example? If any of these is "yes", you should begin a back exercise program before you go on to a fitness program. That's okay, you can do more than one area at the same time, and you will feel wonderful just from beginning these exercises. If all of these are "no", you can probably go one to the next level of the examination: Sit on the floor with your legs extended in front of you. Now lean forward with your arms outstretched. Can you comfortably reach your fingertips beyond your kneecaps? Lie on your stomach. Are you able to arch your chest and legs upward painlessly? Are you able to move your back in all six directions--bend forward, bend backward, bend to the left, bend to the right, twist to the left, twist to the right? Can you do so comfortably? Are you able to do five curl-ups? If all of these are "yes", you're probably good to go on the fitness program for the back. If any of these is "no", you should proceed with the back strengthening program suggested in the next post.

Knee Strengthening Program, second level

Knee Extensions One does need a knee extension machine to do these. I'm using a half-gallon jug of water and an ace bandage, just four pounds but it's better than nothing. A small can of black-eyed peas would work, even, if you're really weak which I'm sure plenty of women in their eighties are, but if you'd like to grow up to be steady on your feet the way you were when you were ten years old, a strong leg is the only place to start. I'd been flexing my quadriceps for two weeks when I realized finally that I was ready for something more. I considered getting strap-on weights for my ankles but I'm poverty-stricken and decided the ace bandage, which I already have, and something heavy, which could be anything that I'm not afraid to drop on my apartment floor (poor Carrie, who lives below me downstairs, is always having to listen to Ms Butterfingers dropping stuff, even at three in the morning, since I have insomnia). At any rate, until I can feel rather confident about my Ace wrapping skills, I won't be doing these at three a.m. So anyway, let's assume you're well heeled and you have at least a membership to the local Y, or more likely a private fitness club, and therefore you have access to a knee extension machine. That's the sort of weight machine where you sit on the end of the bench and put your feet behind the lifty thingy where the weights are. The job is to find out how much weight you can lift with the stronger of your two legs. If it were I doing this, I wouldn't stress too much about lifting the maximum possible on my first week's visits. I am, after all, trying to rehabilitate a very sore joint and its attendant muscle. Garrick says to lift the weight slowly and hold it steady with your knee straightened all the way, for three seconds. So now you have a good idea how much weight your strong leg can lift, you're going to try to lift 1/4 that much with your weaker leg. Lift and hold for three seconds. If that doesn't make you pass out, try 1/2 the weight, then 3/4 the weight. Use your common sense to determine if you should go up to the next level. If you get to 90% of the weight, Garrick will allow you to consider yourself balanced. At any rate you now know what is the maximum your weak leg can do. Here's the strengthening program: Take your max weight, then figure out 1/4, 1/2, and 3/4 of that weight. Now do ten reps at 1/2, ten reps at 3/4, UP TO ten reps at 100%, then cool off with 10 reps at 1/4. This assumes you may not be able to do any reps at all, but eventually you will. So, in brief: 10 reps at 1/2 10 reps at 3/4 however many at full 10 reps at 1/4 Don't think you have to advance too quickly. Increase all levels by 5 pounds, and that should be considered a goodly amount of progress. Do not make anything hurt. Love to all! Granny

Knee Strengthening Program, first level.

Level One This is the exercise that got rid of my swelling, eased the pain, and is in the process of making my thigh muscles stronger than before. Sit on the floor / hard bed / chair with a footstool with your legs straight out in front of you with your heels resting on something that allows your legs to be straight and not flexed. Contract your quadriceps. Remember that your quadriceps is the large thigh muscle on the front of the leg just above the patella. Imagine that you are pulling your patella toward your body. Feel the vastus medialis--you should be able to put your fingertips on it as you contract and feel even a slight flexion. Your goal is to feel it get hard when you do that. If you haven't exercised in twenty years, it's not going to get very hard today, but you should feel SOME movement under there. If you do, that's great. If you don't, you probably aren't understanding what to do. Release it and try again. Watch your kneecap and try to pull it higher on your leg, or put your hand on your leg above your kneecap and feel for some movement. Still no results? Think about lifting your foot (just your foot, not your knee) up an inch. I'll bet that causes a contraction. Keep trying till you can feel something there. You'll soon get the hang of doing this contraction on command. If you just can't do this, try the other exercise four paragraphs down. Contract the muscle, hold for a count of six seconds, relax for three seconds. Contract four times. That's one set. I misremembered how many times to do this and did them a LOT the first day and the second day I stayed with that number. Your goal will be to work up to doing more contractions, and more sets. I'm now doing twenty contractions for each set, twenty sets per day, and my knees are just as happy as they could be. You're probably supposed to do these with both legs at the same time. I did them separately so I could concentrate on doing it. I did first the vastus medialis in one thigh, then the other, then came back to the first thigh for the other side of the quadriceps--the vastus lateralis, on the thigh to the outside of the patella--and then did both of those. Now I'm doing them together, which still doesn't guarantee that they're working equally hard, but there's another exercise to do later which will tell me whether I'm working them both the same amount. For people who couldn't do the above exercise, or didn't much enjoy doing it, there is always this one: Same seating position, but under your knees you place a rolled up towel. Now press down on the towel with your knees. Doesn't require a lot of concentration and not particularly spectacular control, so it's a little easier to get the hang of it than the towelless version. Same number of contractions and same number of sets. So, to summarize: Contract, hold for six seconds, relax for three seconds. Do three to four contractions Do fifteen to twenty sets per day Continue doing these for the rest of your life and keep that quadriceps toned. Garrick doesn't say to increase the number of contractions per set, but I'm doing 20 contractions (sometimes more) in 20 sets per day. I hope that's not excessive. Next level will be in the next post.

The Knee

This is the big problem joint, where over 25 percent of all problems are located. If we were talking about life in general, I suspect we'd be looking at back problems, and those are in the next post. Most joints involve some sort of bone support that seats two bones together nicely, and the muscles hold them together. The knee is less solid than the hip, which has a bone with a ball on the top of it on which rests the pelvic girdle with a socket for that ball to fit into. Then ligaments hold the ball in the socket, easy and happy. The knee is less secure. The bones meet up, both of them flat on the ends that meet in the knee. The ligaments tasked with holding them together are numerous, but they must also allow the knee to flex. On top of everything, they must not allow the knee to flex in both directions but only toward the posterior. A tough task but one they do rather well unless we decide to injure them. Once they get torn, they may never be the same again. If you don't take especial care to rehabilitate and strengthen the muscles of this area, you could be cursed with a weak and painful knee forever. what's more, a knee that has been injured before may be the more easily injured again. Another problem comes when you had an injury requiring surgery or immobilization in a cast. This can lead to premature wear of the joint.If you had a knee injury involving cartilage or ligament damage, you can cause your knee to wear out earlier than it might have done otherwise. look for signs such as aching or swelling when you use the knee, locking or giving way, loss of flexibility. These problems may not be bad enough to keep you from your sports or fitness activity, but don't ignore them when you choose which activity you're going to pursue. Consider cycling instead of running, for instance, or if you're going to swim laps, the crawl is easier on your knees than the breast stroke. If any of the above symptoms sound familiar, consult a doctor. The most common source of knee injuries is overuse. That's what I did; I started walking two miles a day when I had been shut up in an apartment for years. So if you like to exercise you should keep in mind that though you might not feel like stopping when you should (that's before you hurt yourself), you do need to, or when you need to cut back, you need to force yourself to do just that. If I run into this problem while I'm trying to get to my goal, I w8ill do that. Or else. But then, while I'm expecting to work hard toward this goal, I can promise that I won't be beating myself to death to get there. Overuse injuries are usually what happens when you attempt an activity that's too strenuous for strong you are or how much endurance you have. In fact it's having a quadriceps that isn't strong enough that is most likely to cause your knee to suffer. The quadriceps is the large muscle at the front of your thigh, just above the patella, your kneecap. It is responsible for much of the work in stabilizing the joint and keeping the kneecap tracking properly. If you overwork the quadriceps, or if both sides of the muscle aren't balanced, the kneecap can get moved to where it isn't tracking properly, and that's the beginning of a world of hurt. Your knee may ache after activity, then as the injury becomes more severe your knee may hurt and grow stiff when you sit with your knee bent for a long time. Then you may notice pain when you climb or descend hills or stairs. The pain is usually in the front of the knee, behind it or surrounding the kneecap. Or in my case, it was all three of those. Finally your knee may swell and feel tight, or it nay collapse when you lest expect it. At the very least these symptoms indicate the need for a stronger quadriceps muscle. Let's look at your knees: Knee Examination. First do what any good doctor does: ask yourself these doctor's questions: Have you ever been advised to wear a knee brace? Does your knee feel loose" Does your knee give way or lock? Does your knee swell with activity? Is your knee swollen now? If you had to admit to any one of these with "yes", go see a doctor. According to Garrick, you have a serious knee problem. If all answers were "no", go on to the next section. Does your knee hurt when you climb up or down hills or stairs? Does your knee hurt or ache when you sit for long periods of time with your leg bent, as in a theater? Does your knee feel weak, as though it's going to give way? If you answered one of these questions with a yes, then before you begin a fitness exercise program you need to make sure that the strength of your bad leg is equal to the strength of the other leg. More on that shortly. If all your answers are no, go on to the next section. You may be in fine shape, but you may still have discrepancies which are subtle and need to be caught before you start exercising. Sit on the floor with your knees extended out in front of you. Or if your bed is a firm one, sit there. Or in a chair with a hassock in front of you as you rest your heels on it. Look at the dimples on each side of your kneecap. Are they equally prominent on both knees? While still sitting with your knees straight, tighten the muscle in the front of your thigh, the quadriceps. The part just above your kneecap and to the inside is the vastus medialis. Observe how large the muscle is, compared to the other side. Feel the tone of the muscle with your fingertips. Are both sides the same in size and hardness? Sit in a chair and extend your legs in front of you. Do both knees straighten out to the same degree? Lie on your stomach. Bend your knees as far as you can. Are both your heels an equal distance from your buttocks? Stand on one leg, the other leg bent and the foot raised so that it doesn't touch the ground. Are you able to do a one-legged squat from that position. It doesn't matter how far you can go, but can you do the same with the other leg and squat just as far down? The point of this is not to see how strong you are but to see if you can do the same on both sides without pain? If you have access to a knee extension machine, can you lift the same amount of weight on both sides? Can you lift at least 15% of your body weight with each leg? If you can't, your leg or legs are weaker than they should be and you should start bringing both of them up to par. If your legs test out pretty much the same, it's an indication that your knees are balanced and you may be good to go on your exercise program. But if one knee is weak, that could be a problem or even an injury just waiting to happen--especially if you've been working around an old injury that was never properly rehabilitated. So if your self-examination turns up a discrepancy between the sides, you had better start on a strengthening program foefore you do anything else. Don't worry, it may cost you a week or five now, but that's better than needing six weeks of complete rest later. continued in the next post.

Introduction: Don't start your own program till you've diagnosed any problems

You can reduce a lot of physical pain by strengthening your muscles. But you can also cause a lot of pain by doing things wrong, or trying to strengthen muscles the wrong way, or by exercising muscles that just aren't up to the load yet. That's what I did. I had to move into an area where I couldn't keep a car, so I walked everywhere. I figured I was doing my legs a lot of good, giving them all this wonderful exercise that they hadn't been getting in years. And as a matter of fact, I was. But my knees weren't ready for the sudden work they had to do. This housebound person didn't know it but she put a huge load of work on fifty-eight year old knees, work they hadn't seen on a regular basis since my college days, which ended when I was 26. That's thirty-two years of not getting a lot of exercise. Small wonder that a lot of pain started shooting through my legs. Now, see, I have a bit of arthritis in my hands. Just the distal knuckle in some of my fingers. They're a bit swollen, and they look ugly to me. So when my knees started hurting, I assumed they had arthritis in them, too. Especially since I would start walking, they'd be stiff, and then the pain would go away after about half a mile. Eventually the whole problem vanished. Then it came back again, with a vengeance. It seemed seasonal, so I walked even more. The knees started getting stiff when I wasn't able to stretch them out or move them around, such as happened when I was sitting at a desk in the library. I never figured out what was wrong, until I was seized by an urge to start exercising. I wanted earnestly to get into the shape I wanted to be in whilst I was in college, and now that I was free to do so, I couldn't think of anything to stop me. Except for my sore old knees and my painful old shoulder, that is. I went to the library and checked out some lovely books. I purchased a copy of "How to Keep Slender and Fit After Thirty", a book full of great, indexed exercises which I had owned since I was sixteen and which my ex had tossed out, along with everything else I owned. One of the books was the Marine Fitness manual (unofficial) that gave me permission to go slowly. "It is a myth," I'm paraphrasing, "that we work you to death in boot camp until on the last day you emerge triumphantly physically fit." Every person improves at his own rate, so uniformity in exercise didn't make a lot of sense. Instead, you will see marines working out on their own, doing the exercises and calisthenics that are most suitable to their getting in shape. Then followed a section of graduated exercise. They don't throw you to the floor and demand thirty pushups. They explained how to start at your own level, such as doing modified push-ups, then work your way up in difficulty. I'll explain this at a future date. The other book I got was one of the most valuable fitness books I've ever had in my hands. "Be Your Own Personal Trainer". Chapter One told the story of a couple of typical people who had started out on a fitness regimen while not knowing what they were doing. The husband was a former football jock, the wife his reluctant companion in what to her was a new enterprise. The husband had been out of training for fifteen years, thought he knew exactly where to begin, and ended up tearing muscles just from jogging the first day. The wife had developed tennis elbow from working muscles that had never worked before--two of the most common problems when inexpert people take up an exercise routine. Then they walked us through some self-diagnostics, which is very important. I will put in a post about the knee first, with its own section on diagnosing problems because there is a request for it. It's already got me walking without knee pain, and another older woman at my church is doing the very simple, very gentle exercise I taught her, and feeling very good results from it. I'm going to be rash and jump into Knee exercises and Back exercises right away, then write the overall diagnostic section, then come back and edit the knee and back sections. For now, the knee and back sections are going up tonight. Oh, and the reason for the haste is that I'm going to copy and paste these sections into the actual blog in just a couple of days. See you on the next two posts.