Old Dog, New Tricks: When Dog Paddling Doesn’t Work In the Triathlon

Four years ago, I completed my first triathlon. I knew I would be able to do it, but there was just one thing. Triathlons involve running, biking and swimming. Running and biking I had mastered—hard work, but I have confidence and can count on my body to move in all the right ways. Swimming, on the other hand, was just not my sport. Determined to finish all legs, I struggled through the swim doing the dog paddle. Yes, the dog paddle.

Clearly, this dog needed a new trick if competing in triathlons would be a reality for me. It was time to learn to swim. Really swim.

I’d taken one swim lesson before that first triathlon. It didn’t involve a lot of “swim” time, but taught me the basics like how to position my face and arms in the water, but not too much more. To prepare for this summer’s triathlon, I decided to take a lesson with a Y instructor who is also a triathlete. This time around, I learned more about form and pacing and gained some confidence, finally.

I always thought swimming was going to be “easy,” or that it should be easy if I could just learn the basics. Well, it’s not easy. I’ve learned that it takes a lot of practice and patience. There was nothing natural or familiar about swimming. From childhood into my adulthood, moving my limbs in that dog paddle and holding my head high without getting my face wet had become familiar. It was time to make new movements familiar and get past my fears of cramping up, drowning or just not finishing. Patience.

At one point, while I was practicing in the pool, a well-known triathlete witnessed my struggle and came to my rescue. At the end of every lap, I’d rest, catch my breath and summon the courage to do another. Stop, start, stop, start—it was a technique that would never work in a real event on open water. He offered some simple advice that I never would have come to on my own. He told me to swim four laps instead of one, take a 30-second break and then swim again. I resisted. He actually said “I’m not leaving until you do it,” so I did it. Ever since then, I’ve been able to swim a lot less like a dog and more like a fish! (A slow fish but, nonetheless, a fish.) I had to get over the fear of “not being able to do it.” Since then, I’ve been able to swim nonstop for 800 yards. I’m slow but I can do it!

And this summer’s triathlon? No problem. I completed it without struggling. I’m confident in the running and biking events and I’d describe myself as comfortable in the swimming event. Confidence is coming. This triathlon was so much better than the one I did four years ago. I was way more relaxed and NOT exhausted when I was done. I was still slow, but I was mentally ready for the bike and run because I no longer feared I’d die from the swim! I enjoyed the whole thing.

The best part is that I’m a swimmer now. This summer, we’ve been swimming at several small local ponds. It’s actually kind of scary because the water is dark and there are turtles and weeds—not the clear water and blue bottom of my lane at the Y. I swim with a wetsuit on, though, so I feel like there is a barrier between me and the “gross stuff.” I also swim with other people, and that makes it even more fun and not a “job.”

I can almost be in a meditative state while I’m swimming. My body also likes the non-impact activity, that feeling of gliding.

When I look back to all those years as a non-swimmer, I feel kind of sad about what I missed. I wish I’d known how relaxing it would be. I can almost be in a meditative state while I’m swimming. My body also likes the non-impact activity, that feeling of gliding. After a hard workout or run, it always feels good to get in the water and just swim. I’m stretching my limbs and breathing rhythmically. It’s quite nice…unless I see a snapping turtle.

Coming into a new sport a little later in life has taught me so much. I am always open to trying a new skill, and clearly finding my inner athlete has been really good for me. Learning to swim has helped me realize that nothing is really unattainable; I just have to keep trying and practice patience with myself.

What’s ahead? I like to think anything I’d like to try is mine to try. I would definitely love to try mountain biking or ice climbing. Of course, I’d have to do it without my family and coworkers finding out. They might just put me in a body cast before I even started!

~ Melissa John-Pendleton, Office Manager

 

Shake Hands with Your Feet: Simple Strategies for Plantar Fasciitis

Women Playing Tennis

This may sound like a hokey way of thanking your feet for keeping you upright and moving for an average of 5,000 steps per day. But, if we multiply that number by 365 days in a year, that means our feet take us an average of 1,825,000 of steps per year. And that number does not include steps for sports related activities or targeted exercise. So, I guess thanking your feet is not such a bad idea, but my point is a little different.

One can imagine that taking an average of 5000 steps per day can create foot pain that makes it hard to walk and even harder to keep up with your tennis game! This has happened to me as well as my teammates on our United States Tennis Association (USTA) Women’s Tennis League. People may be familiar with the term “plantar fasciitis” or, more simply stated, pain on the bottom of your foot that makes it hard to walk without limping, especially first thing in the morning or after any period of rest, like sitting at your desk for an hour or more. Your plantar fascia is dense connective tissue that runs from your heal to your toes, and because it is on the bottom of your foot, planar surface, it is called plantar fascia. When this fascia gets inflamed it is called fasciitis.

There can be many reasons for this inflammation, and for us tennis players it is usually too much tennis, specially on a hard court, without proper footwear and post-exercise stretching. By proper footwear, I really mean changing out our tennis sneakers at least every six months. A good way to see if your sneakers are ready to be tossed is to look at the tread on the sole, especially around the ball of the foot. Because we spend so much time on the balls of our feet ready to spring off and get to the next shot, the forward sole of the sneaker wears the most. Also, if you can easily push your thumbs into the ball of the sneaker, it is time for a new pair.

Now, let’s talk about shaking hands with your feet or post-exercise stretching for the hard working muscles inside of your foot.

Muscles like to be stretched after they have been used during an athletic activity, so to get to the small but powerful muscles of the foot do the following:

  • To stretch the left foot, bring the left foot up onto your right thigh and, with your socks off, put the fingers of your right hand in between your toes. When you first start it may be painful and difficult to get your fingers in between the toes but that just lets you know how tight you little muscles are! Once to get your fingers in there move the foot and toes up and down and side to side trying to loosen the foot up. Then repeat with the other foot and other hand.
  • Now, lets target the big toe. Stand in front of a step and place the bottom of your big toe up against the riser of the stair and bend your knee until you feel a pull on the bottom of the toe and foot as well as into your calf. Stretching like this should never be painful but should feel tight and I recommend holding the stretch till the tightness starts to ease a little. In the lower leg that can be a minute or longer.
  • Most people are familiar with stretching the calf or the back of your lower leg by standing with your hands against a wall and stepping back with one leg, keeping the knee straight and leaning forward, or standing on a step and letting your heels drop off the step with your knees straight. Both of those are good stretches, but my favorite is standing on a slant board (see picture). You can make your own slant board by getting a piece of 2 by 4 and a flat piece of wood big enough for your two feet to fit on or go on Amazon and search for “OPTP Slant.” Just stand both feet on the slant so your toes are on the high side. Again, I like to hold that position until the stretch feeling starts to subside a little. And the higher up the slant you stand, the stronger the stretch, so you can start with your heels on the ground and steadily walk up the slant as you progress.

I was able to catch my plantar fasciitis early by doing the above stretches after tennis, as well as after my boxing class (another sport that keeps you on your toes), and I did not miss any time on the courts! Remember listen to your body, have the right equipment and start all new exercise routines slowly and gently to see how your body responds. And! Visit your neighborhood physical therapists if you have trouble recovering from injuries, because that is what we help people do.

~ Brigitte Cook, PT

Can What I Eat Really Change My Arthritis Pain?

I am a physical therapist and I have arthritis pain. There, I said it. Not a hard admission after all!

Recently, many of my patients have been asking about things they’re hearing about helping arthritis pain by eating an anti-inflammatory diet. It got me thinking about my own eating habits, and wondering if there might be room for change.

Nutrition is not my specialty, so I’m careful to avoid giving advice outside of my physical therapy realm. I took nutrition courses in school, even keeping up by taking more nutrition courses after college, and I know finding good information can be a challenge. I have concerns about patients, family and friends seeking information from less than reliable sources. In very little time searching, I found numerous websites, magazine articles and even television programs touting the “right” anti-inflammatory diet. Some information seemed like downright quackery. I looked for well referenced information from established, medically credible organizations. That seemed to me to be a safer bet than taking nutrition advice from a television show host!

After lots of reading, my search settled on a few credible websites offering good anti-inflammatory diet info. Dr. Andrew Weil, M.D.  is the Director of the Arizona Center of Integrative Medicine and an internationally known expert on healthy lifestyle. The Arthritis Foundation  is a well-rounded source for a variety of information for arthritis sufferers, including healthy diet information.

The fact-based information I gleaned was best summed up by Dr. Andrew Weil, M.D. An anti-inflammatory diet should be balanced and break down into acceptable proportions of carbohydrates, protein, healthy fats and other nutrients. It should optimize mental and physical health along with disease prevention.

I am spending more time preparing fresh food, but it tastes so good that it is worth the extra time.

Inflammation causes and/or exacerbates some chronic diseases like osteoarthritis. COX2 enzymes have been identified as probable causes of persistent inflammation with resulting osteoarthritis pain. Blocking these enzymes may decrease inflammation and may even prevent or lessen age-related conditions and diseases while promoting overall wellness. I was surprised to discover there are real “trigger foods” that let your arthritis take control of you, instead of vice versa. Sugar is one of the culprits, as are the inflammatory fats in many processed foods.

I also learned there is a unique shift that our bodies make during our twenties which may be partly behind the arthritis pain of some of us experience in later years. Up to the age of approximately 27, we produce proteolytic enzymes, long used in Europe to block COX2 enzymes in the treatment of inflammation. These proteolytic enzymes attack fibrin in our bodies—that’s a protein that seals off the sites of inflammation with scar tissue. Without those proteolytic enzymes, that scar tissue is not “digested” and related toxins are not cleared away. Anti-inflammatory diets with healthy doses of proteolytic enzymes from foods like pineapple, papaya and many spices like ginger may “flip the switch” inside our bodies to counteract the promotion of arthritic changes and subsequent tissue damage.

Some “pros” of an anti-inflammatory diet:
  • Convenience: variety is encouraged, no there are no strict meal plans.
  • Recipes are available from the professionals.
  • You can eat out (yay!).
  • You can feel full and satisfied.
  • You can drink alcohol in moderation.
Some “cons” of an anti-inflammatory diet:
  • Meal prep may be more time consuming if you’re used to using a lot of processed foods.
  • Fresh food can be a bit more costly than processed or prepackaged food.

As a physical therapist, I must add that exercise should be part of the overall regimen in any holistic approach to wellness, including efforts to decrease inflammation. All in all, what nutritionists, naturopathic physicians and registered dietitians recommend is a sound diet that is healthy and gives a lot of freedom of choice, not a lot of sacrifice.

These are a few “nuggets” that I have put into action. I continue to shop the perimeter of the store for fresh food, going into the aisles for pet food and household items only. I now eat more of the recommended foods and avoid foods with simple sugars, which are inflammatory. I am spending more time preparing fresh food, but it tastes so good that it is worth the extra time. I stopped beating myself up, thinking my osteoarthritis was due to “overdoing” it with various things like my job and recreational activities. I realize now my body was going through unavoidable changes but that I can do things to ease inflammation. Lastly, and quite important to both me and my husband, enjoying a meal at a restaurant is possible by making thoughtful choices!

The most important point to remember, if you are contemplating trying a few dietary changes in an attempt to decrease osteoarthritis pain or other inflammation, is that there are some medically approved, scientifically researched diets out there.

I’m in!

~ Marion Howell, PT

Going for Red: Women and Heart Health

Melissa, Donna and Tamara, after engaging in some heart-healthy exercise.

This month I celebrate Go Red For Women, a campaign for heart health by American Heart Association. I write about this public health awareness effort in memory of my dad, and in honor of my mom. Every minute in America, a woman dies from a heart attack, stroke or another form of cardiovascular disease. Heart disease is the number one killer of women in the United States. According to the American Heart Association (AHA), most of these deaths are preventable.

Every minute in America, a woman dies from a heart attack, stroke or another form of cardiovascular disease. …most of these deaths are preventable.

Women’s heart symptoms can be different than men’s. Women are more effected by a “silent” heart attack, which has unrecognizable symptoms like indigestion or flu-like symptoms. Even strained chest or back muscles can be signs of a heart attack in women. Symptoms of anxiety and fatigue should not be ignored. Blood flow to the heart muscle may impaired during a heart attack, and can lead to scarring and damage to the myocardium or heart muscle, leading to additional cardiac dysfunction. Listen to your body and discuss any unusual symptoms with your doctor. Your doctor should also be aware of any family history of heart disease since it is an important risk factor for cardiovascular disease.

The American Heart Association lists seven ways to help control your risk of heart and vascular disease:

Get Active. Be sure to get at least 30 minutes of moderate exercise, five days per week.
Reduce Cholesterol. Too much “bad” cholesterol (LDLs) can increase plaques in your vascular system and increase the risk of heart attack or stroke.
Eat Better. A 2000 calorie diet should include 4.5 cups of fruits and vegetables daily, 3.5 ounces of oily fish per week (think salmon), three 10 ounce servings of fiber-rich whole grains daily, four servings of nuts, legumes or seeds weekly, and no more than seven percent of total daily calories from saturated fats. Restricting salt, sugar and processed meats is also recommended.
Manage Blood Pressure. High blood pressure is a major risk factor in cardiovascular disease. Decreasing stress, eating a healthy diet and taking medications can be helpful in reducing hypertension.
Lose Weight. Losing five to ten pounds can produce a dramatic effect on blood pressure. Your healthcare provider can help you determine if you need to lose weight based on body mass index.
Reduce Blood Sugar. Per AHA guidelines, your fasting blood sugar should be below 100. Higher readings may indicate a diabetic condition that significantly increases you risk of heart disease. Decreasing simple sugar intake can be helpful in reducing blood sugar. READ LABELS to identify sugars hidden in foods.
Stop Smoking. Smoking damages your entire circulatory system, increasing risk of heart and vascular disease.

I am keenly aware of the importance of cardiovascular health since my dad died at the age of 44 from heart disease. I believe strongly in the importance of regular exercise and healthy eating. As a physical therapist, I work daily with my patients in treatment that enables them to increase activity to keep a healthy and happy heart. So get out there and walk, run, spin, ski or hike often and remember: your heart depends on it.

~ Donna Lannan PT

The Vital Heart: Breathing to Support Heart Health and Resilience

I am always ready, if not quite happy, for this time of year. The earth has entered a period of darkness and stillness. In the evening I am ready to retire to bed at an earlier, healthier, hour. After the rush of the holiday season, I am able to spend more time at home with a specific emphasis on enjoying the subtlety of being.

It isn’t easy. Half the time I am wondering what I need to be doing that isn’t getting done. But I do have a little more spare time to relax, since I am not eager to get out into the cold weather. The question that I ask myself is “What do I DO to relax?” Well, isn’t that an oxymoron? The idea of relaxing is NOT to DO anything at all. Oh, yeah, I simultaneously realize and remember that I am not very good at relaxing.

I am just beginning to understand that my health depends not only on being able to have the energy and capacity to perform my activities, but also on my body’s ability to repair and restore itself. 

That is probably the single most important reason for me to learn how to relax. I am just beginning to understand that my health depends not only on being able to have the energy and capacity to perform my activities, but also on my body’s ability to repair and restore itself. I look at this as two sides of the same coin: I need to have active heart strength and passive heart strength, the ability to GO and the ability to SLOW.

Through my introduction to heart rate* in school, I learned that the stronger the muscle of the heart, the more blood it pumps with one beat. The one strong pump gives better “oomph” to the blood to travel to all of the body. When the heart can pump more blood more easily, it can also relax for a little bit longer into rest between pumps. And then I learned about heart rate variability. The healthy heart not only needs to demonstrate a well-paced rhythm and forceful contraction (heart rate), but it also needs to respond to the demands of life throughout the day (heart rate variability). Having the heart at one steady rhythm isn’t always the best thing. For example, less blood needs to be pumped when relaxing reading a book and more needs to be pumped when shoveling the snow. It’s like being able to go from 0 to 60 mph easily, and then return to idle at a gentle hum. One major difference between heart rate and heart rate variability it that the variations in heart rate are in response to the nervous system, and not just in response to the effort.

A person with higher heart rate variability has a heart and body with strong ability to tolerate stress.

Heart rate variability (HRV) is the variation in the length of the interval from one beat to the next. Throughout the day, the heart needs to balance signals to GO (sympathetic) and signals to SLOW (parasympathetic). The truth is, many of us are so busy going and responding to stress that we don’t adequately allow time for the heart to bounce back after a stressful situation by following it with rest. A person with higher heart rate variability has a heart and body with strong ability to tolerate stress. Sadly, this is difficult to measure. An electrocardiogram is the best tool, not readily available for use at a patient’s request.

The amazing thing (to me) is that heart rate changes slightly in every breath. The inhalation causes a slightly increased heart rate, and the exhalation creates a slightly slowed heart rate. So we have an access point to directing heart health since we can consciously control the breath. Yay! Research has begun to reflect that there are breathing, meditation, body awareness and relaxation, and self-compassion practices that can help to increase heart rate variability (despite physical fitness level). Following are two breathing practices to help access the parasympathetic nervous system to rest the heart.

Diaphragmatic breathing is the first technique and is the basis for all other breathing techniques. When the diaphragm participates, the parasympathetic nervous system (the part of the nervous system that tells the body and brain to SLOW) activates. The diaphragm is a muscle between the cavities of the lungs and abdomen that contracts as we inhale and relaxes as we exhale. The goal of this breath is to train the body to be a “belly breather.” To begin, lie down with one hand on the belly and one hand on the chest. As you take a few breaths, try to breathe through the nose. Take note of which hand rises first when you inhale. You will become better at recognizing the pattern as you practice connecting to the sensation of your abdomen and ribs during breathing. Begin to soften the belly with the inhalation and feel the belly-hand rise. During the exhalation, expel the air from the abdomen by tightening the muscles, feeling the hand on the belly descend. Try pursing the lips during the exhalation as if you were blowing out a candle to help instigate the correct muscles. Performing diaphragmatic breathing for 5 to 10 minutes in this way will be effective in accessing the stress-reducing qualities. Hopefully, as you progress, you will find that you can easily do this seated upright. In addition, you might find that you are able to train the body to breathe diaphragmatically rather than from the chest!

Equal length breathing builds upon the diaphragmatic breath. It asks the participant to begin to set a rhythm to the breath making the length of the inhalation match the length of the exhalation. One research study (Lin) showed that the most effective pace for reducing anxiety and increasing HRV was 5.5 breaths per minute. This roughly translates to a 5.5 second inhalation to exhalation ratio, but for the sake of ease, let’s call it 5 seconds. You can set a metronome, listen to a clock ticking, or simply count to yourself. As in the first exercise, find a comfortable position, breath through the nose, and use diaphragmatic breathing. If it is difficult to lengthen the breath to a 5:5 second ratio, start by noting the length that makes you most comfortable. After several breaths at that ratio, begin to lengthen the exhalation by one second for 10 rounds. Once you are comfortable with lengthening the exhaling, match the inhalation to that length. Work up slowly, possibly over several weeks, until 5:5 becomes comfortable. The duration of these breathing practices can begin in a set of 10 rounds (approximately 2 minutes), but may increase to as many as 30 or more breaths (5-6 minutes) to reap greatest benefit. Pay attention to your experience as you practice the exercise, you may feel your mood shift as you breath. One research study (Krygier) even showed that more important than the effect of the technique itself is the positive immersion of the participant in the task. If you find yourself distracted and would rather be somewhere else, the technique won’t help!

These practices are an introduction and a beginning. They can become increasingly effective when combined with body relaxation and meditation practices. They are also most effective for heart benefit when practiced consistently. So, during this season when you might find you truly want rest, take a few minutes in the morning, evening, or after a stressful situation, to try employing one of the above techniques. The health of your whole body will benefit.

~ Courtney Germano PT, DPT

*How to take your heart rate: Find your pulse at the thumb side of your wrist or at the side of your throat using your first two fingers laid gently over the skin. Count the number of pulses in 10 seconds and multiply that number by 6. This is your heart rate at rest. It will be lowest in the morning just at waking, and gets faster as you do more activity. Please see Jeff Clough’s post Walking for Heart Health from May 2016 for more information on heart health.

 

References

Krygier J, Heathers J, Shahrestani S, Abbott M, Gross J, Kemp A. Mindfulness meditation, well-being, and heart rate variability: A preliminary investigation into the impact of intensive Vipassana meditation. 2013 Sept;89(3):305-313.

Lin IM, Tai LY, Fan SY. Breathing at a rate of 5.5 breaths per minute with equal inhalation-to-exhalation ratio increases heart rate variability. Int’l J of Pyschophysiology. 2014 Mar;91(3):206-11.

Arch J, Brown K, Dean D, Landy L, Brown K, Laudenslager M. Self-compassion training modulates alpha-amylase, heart rate variability, and subjective responses to social evaluative threat in women. Psychoneuroendocrinology. 2014 Apr;42;49-58.

Brown RP, Gerbarg PL. Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I-neurophysiological model. J of Alternative and Complementary Medicine. 2005 Feb;11(1):189-201.

Chandra SS, Sood S, Dogra R, Das S, Shukla SK, Gupta S. Effect of short-term practice of pranayamic breathing exercises on cognition, anxiety, general well being and heart rate variability. J of the Indian Med Assoc. 2013 Oct;111(10):662-5.

Dishman RK, Nakamura Y, Garcia M, Thompson R, Dunn A. Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. International J of Psychophysiology. 2000; 37(2):121-133.

MacArther Research Network on SES & Health. The John D and Katherine T MacArthur Foundation, UCSF. Accessed Jan 17, 2018.

Mark’s Daily Apple, How to Increase Your Heart Rate Variability. Mark Sisson. https://www.marksdailyapple.com/how-to-increase-your-heart-rate-variability/. Accessed Jan 18, 2018.

Miu A, Heilman R, Mircea M. Reduced heart rate variability and vagal tone in anxiety: Trait versus state, and the effects of autogenic training. Autonomic Neuroscience. 2009;145(1-2):99-103.

Russell ME, Scott AB, Boggero, Carlson. Inclusion of a rest period in diaphragmatic breathing increases high frequency heart rate variability: Implications for behavioral therapy. Psychophysiology. 2017 Mar;54 (3):358-365.

Torok T, Rudas L, Kardos A, Paprika D. The effects of patterned breathing and continuous positive airway pressure on cardiovascular regulation in healthy volunteers. Acta Physiol Hung. 1997-1998;85(1):1-10.

A PT’s Rotator Cuff Surgery Recovery: Mindfulness and ‘Radical Self-Care’

Julie first wrote about her shoulder repair surgery last July, sharing some of her experience of the first several weeks of adapting and healing. Now, more than a year and a half out from the surgery to repair two large, complete rotator cuff tears, she shares her thoughts about the ongoing work she calls “radical self-care,” and all that’s involved in keeping that shoulder healthy. Julie has chronicled her progress through journaling because, as she says, “At each point, it’s good to look back and reflect.” In this interview, she shares some reflections on the process with us.

Q. It’s been a year and a half or so since your rotator cuff repair surgery. Before we get into how that year has been and all that you’ve learned, how’s your shoulder feeling now?
A. It’s very functional these days, but not like when it was a 20-year-old shoulder. I’m really pleased with what I can do; still, it’s been an ongoing process of knowing when to be careful. Sometimes I’ll be doing something and it just sort of feels like it’s too much. It might be a task like helping stow the kayaks in the barn, with my arm overhead, and it won’t feel quite right. When the shoulder gets achy or sore, usually a day or two later, I think, “Okay, what have I done?” And I have to totally respect that it’s not something I can just bull through. So, I’m generally back, but there are definitely things I’ll never do again, like lift bales of hay or kayaks overhead. Still, there’s been a significant change in my function since before surgery and I’m really pleased with that.

Q. How did you approach healing from your surgery? 
A. I was out of work for a total of four months. Because of the size of the surgery, it was a slower process. For eight weeks, I was not allowed to do any active motion; I just had to let it heal. I knew that at 12 weeks, that tendon would be only 60 percent healed, and that complete healing wouldn’t happen until six or eight months after surgery. By the time I went back to work part-time at four months, it was still not 100 percent there. The two factors affecting success rate with my surgery were age and degree of repair, and I knew I had about a 60 percent chance of success. I was motivated to support tissue healing in any way that I could. That healing process was very much a part-time job during the four months when I was out of work. Everyday tasks like cooking a meal took a lot longer and required figuring out new ways to do things. I focused on strategies like getting enough sleep, eating nutritionally for tendon health by focusing on things like protein, bone broth and minimal sugar. And, of course, doing my physical therapy exercises. By the time I went back to work, I had pretty good function and motion, but I knew the work would continue. I had a lot of fear around whether the shoulder would heal properly, and I did everything I could to turn that fear around into positive energy and motivation.

Q. What was it like to get back to work?
A. The whole return to work part was very interesting. My job is so physical. I knew I needed to be very careful about how I used my shoulder at work by modifying manual therapy techniques and specific challenges like lifting. I had to retrain my body, focusing on details like engaging my shoulder blades to support the work of the shoulder itself. I had to practice a lot of mindfulness with every movement, retraining my body and creating new ways to use my arms. I transitioned into full-time work after two weeks of part-time. I knew I’d be tired, and I was, but I was surprised by how long it took to feel like I was on my game clinically again, until I felt fully confident. It was almost like I needed to retrain that part of my thinking, like a muscle that hadn’t been exercised. All in all, it was a couple of months before I was in the swing of it. I told myself that I didn’t have anything to prove to anyone and I didn’t have to be a superwoman. It was good to keep that in mind, and know that whatever I did would be fine. I knew that I was still healing and wouldn’t hit the max point of tendon healing until seven or eight months out.

Q. When was the first time you really felt like your shoulder was working well?
A. The surgery was in June of 2016, and it was at some time the following spring that I realized I wasn’t thinking about it every minute of every day. It felt really good. I’d been increasingly active during the winter, but I didn’t do any snow shoveling. I did ski and snowshoe and get out into the woods. I felt like it was healing well.

Q. Is there any activity you continue to avoid now? How do you know?
A. I definitely avoid doing too much overhead. I continue to avoid doing any quick or jerky movements, especially those that are out to the side, including pushing and pulling; I keep all use in front of me. I avoid a lot of twisting (things like opening a tight lid to a jar) and I absolutely don’t do any overhead heavy lifting. So, I can pick up a bale of hay if I keep it at waist level, but no higher. I am able to put my kayak on my car, but only if I’m deliberate and mindful. Paddling is fine, but I learned that it’s best if I’m in my own boat. I got back to spinning class, too. It’s always about the mindfulness. I can know it’s too much in the moment, but sometimes it takes a couple of days for my shoulder to bother me, so there’s a constant modification process of what works and what doesn’t work.

The cool thing was when my surgeon said, at almost four months post-surgery, “If I didn’t know better, I’d think you’d really healed this thing.”

Q. Looking back over the last year and a half, what strategies evolved as your favorites for self-care?
A. I realize now I’m not at an endpoint and never will be, and that these tendons can get too stretched out or tear again. The surgery was on my dominant arm, and the shoulder is so important for function, so it’s really up to me. I can do all the things that are important to me, like taking care of the sheep and working in the garden, but I still have to practice active self-care. That involves a lot of mindfulness and listening to what my body is telling me. I keep a daily self-care journal, and take a few minutes to reflect on how my shoulder feels at the end of the day. I’m still following a home strengthening program at least three days a week and being careful not to use the shoulder in ways that make it vulnerable to injury. Nutrition continues to be a big part of active self-care for me. I make a killer bone broth for collagen on regular basis and stick to really good nutrition with lots of protein, diverse vegetables and very little sugar. The cool thing was when my surgeon said, at almost four months post-surgery, “If I didn’t know better, I’d think you’d really healed this thing.” I totally attribute that to a multi-faceted self-care program. I know that you can’t speed up the physiology of healing, that you just have to respect it. It’s easy to push too much, in an effort to get back to normal quickly, so I tried to respect the process.

Q. What do you think was most helpful?
A. I don’t negate the surgeon’s role at all. She really did her job, and did it very well. Still, it’s so much more than that. I do love that term “radical self-care.” It’s not about any one thing, so much as embracing that concept and following through. It felt so important to respect the time and energy that healing requires that healing is a part-time job. For rotator cuff repair, it’s almost a yearlong process and it’s a multi-faceted process. I believed I could have a profound effect on that process, in spite of a not-so-great prognosis for the surgery. The hard part is dealing with what your fears and expectations are. I thought a lot about my worries, concerns and fears and how to shift all of that into a positive focus. I knew my specific surgery had a high failure rate, and I still wanted to do my part.

What I feel like now is that this shoulder experience has been a microcosm of aging. I’ve had to be mindful, be willing to modify how I do things with ongoing adaptation and exercise positive control. It also requires grace.

~ Julie Dewdney, PT

Finding a New Normal

While working with clients, I try to do everything possible to help them return to all their “normal” activities. We’ll typically have conversations about doing things differently or even giving up some of their usual activities, and those conversations are not always easy ones. I’ll say things like, “The system is just not perfect anymore,” and most of the time it seems to help them realize their limitations. At times, though, my clients have been absolutely resistant to making any changes in their “normal” routines. I knew that making modifications would make their lives easier or less painful and, still, some resisted.

I have had to heed this message myself. In my twenties, I tore ligaments and cartilage in my knee. That resulted in having to wear a brace for any hiking, skiing or rock climbing that I did. Then in my thirties, I broke my kneecap badly enough to have half of it removed. Going forward, I had to be more careful in all my sports, yet I continued to do them all. By my fifties, I started to realize my “system was just not perfect anymore.” I gradually did less and learned to be even more careful. In the last year, the lawn has taken two days instead of one day to mow. I might now do half a day of yard work and then rest. Walking is okay as long as there are no hills. These changes happened over time and yet each one was relatively easy to adjust to, as long as I was open to changing routines.

I have fought this change for a long time now, and finally, I traded in my stick shift for a manual.

Then I finally needed to give up my stick shift car; I have been driving one since I learned to drive. I love driving a stick shift because there was always something to do. I had to pay attention more acutely and I enjoyed the challenge of driving those windy back roads, while driving them well. I have fought this change for a long time now, and finally, I traded in my stick shift for a manual.

Now when I am discussing changes my clients are resistant to, I understand. I think of my own struggle to fully understand that my “system was just not perfect anymore.” It’s not always about not doing what we love to do—it’s often about doing things differently.

Maggie Donohue, PT

Kayaking, Blue Gentians and Tending to the Core

Kayaking on Contoocook River

Serendipity often occurs when I kayak, whether on a river or the ocean. Kayaking allows me to focus in on the microcosm of the water/land interface, where so much beauty lies. It also teaches me again how to relax in nature.

Recently I was kayaking on the Contoocook River early in the morning, heading upriver. I caught sight of the red cardinal flower and slid in to get a closer look, only to discover a mass of blue gentians. I couldn’t get over how beautiful they were, and how many there were. I pulled in to the shore, and just rested there. Then I watched a bumble bee land and climb into a blue gentian, head first, until it was hidden deep inside. It eventually came out (rear first) and flew around a bit, only to come back to the same flower. This scene, along with the old roots of a tree reaching to the water and the shimmering light reflecting on them, made for a lovely moment.

Transverse abdominals engaged, good timing on foot rests with the paddle, gentle turning of my torso with each motion.

But I had places to go upriver. As I settled into a steady paddling rhythm, I pulled in my transverse abdominals (one of the core muscles you tighten up and in around the belly button and across the lower pelvis). Once again I felt how wonderfully they work to give me that extra power per stroke, while of course supporting my lower back, too. Then, thinking of my favorite women’s health colleague, I pulled my pelvic floor muscles up and in (that is, the Kegel exercise, but held continuously). The transverse abs and pelvic floor muscles teamed together and I paddled on with increased awareness of both. But soon the water lilies caught my attention and the pelvic floor receded, the transverse abdominals holding on a bit longer.

As I paddled on, I saw turtles basking on an old tree that had fallen into the water; I floated by. Then I saw preening ducks on another log; I floated by them as well. I then paddled into a lagoon, with my core once again engaged, looking for great blue herons. This was not to be, at least with my eyes. As we all know they are very stealthy, and great fisherwomen as well.

By now, it was time for the steady paddling rhythm heading back downriver. Transverse abdominals engaged, good timing on foot rests with the paddle, gentle turning of my torso with each motion. I stopped on Daisy Beach, which is so rarely empty, to stretch my legs. For a change, I felt no back strain or sciatica issues. It was the most enjoyable use of my abdominals I could remember, and so clearly a part of the experience.

That of gentians, kayaking and my core.

Martha Torrey, PT

How My Aging Dogs Helped Me Find New Hiking Trails

One recent  morning, when my “old girl” Hunny didn’t want to do our regular walk, I knew I had to make some changes to our regular routines. My precious pup was now twelve and a half years old and just didn’t have the same energy she did when she was younger—kind of like me. It was clearly time for a change. One of my absolute favorite things to do is to be in the woods with my “girls,”  something we do twice a day, regardless of the weather. Our explorations used to be four to six miles per day, with one walk in the morning and then another when I got home after work. We were all tired by the day’s end.

Our morning walks together got shorter and shorter. It was a change they clearly needed, but it wasn’t working for me. I started trying to figure out how  I could continue to be active and not have them feel left out. I did a little investigating online to see what trails were in my home and work communities. Wow, I didn’t realize the resources available for this! I was able to find lots of different trails through various town websites, groups like Five Rivers Conservation Trust and other random sites.

I made up my mind to pack a bag every morning before I left the house: sneakers, hiking clothes, water and a snack (I like to eat a lot). In the trunk they went and off to work I went. I would plan where I would stop on my way home the night before so I could let my husband know. Monday, I would do Carter Hill trails to Swope in Concord.  Wednesday, I would do the River Walk by the red barn in Contoocook. Friday, I would hit up the trails in Hopkinton. This was fun! Even though I didn’t have my girls with me, I was able to get home at a decent hour and had energy left to take them around our loop and let them enjoy some time in the woods!

As I walked along these trails, it felt good to explore on my own. I knew I was doing something good for my body and mind. It turned out to be a great way to unwind after work, leaving the day’s problems behind.

Routines are great, but it turns out that changing them can offer unforeseen benefits, like getting to know some of the beautiful trails out there that I had no idea existed.  Often times I will try to coordinate with friends to see if they can meet up with me to share the walk; it’s always fun with a friend, even if they aren’t furry.

When I’m in the woods alone it gives me a lot of time to think about life. It’s all about adjusting, making changes when necessary and finding ways to be happy and feel good. Just as importantly, it gives me a chance to just be quiet and enjoy the beauty of the woods, while still getting some gentle exercise.

~ Melissa John-Pendleton, Office Manager

Explore a few local trails! You’ll find many downloadable trail maps online for these and more towns—explore online, and dust off those hiking shoes!

My 4 am Workout: Tai Chi for Body and Spirit

Woman Doing Tai Chi

Even before the alarm goes off at 4 am, I’m thinking about hauling myself out of bed. Even so, 4 am often comes too quickly. In warmer weather, I go out onto my deck; in cooler and wet weather, I patter into a wide hallway and begin my Tai Chi Qong “warmup.”

It isn’t really a warmup like one performed prior to sports or other exercise routines, but a way to stretch, increase my mind’s and body’s focus and open “Chi” channels. These get my blood flowing and loosen up my 60 year old body. I begin my routine of 24 moves that have funny names like “Phoenix Rises to the Sun.” My arms and legs begin their strange looking dance. When I am finished, about 20 or 25 minutes later, I feel refreshed and calm.

I follow this routine faithfully four to six days a week because, even though I loathe getting up so early before work, the benefits my body and mind reap from it are probably what keep me able to do my job, chores and all the other things I enjoy (like chasing grandchildren), without pain or injury.

Tai Chi Qong is an ancient martial art. The version I do is fairly basic and doesn’t have a strong “martial” focus. However, some aspects of self defense training are certainly ingrained into the entire routine. “Chi” is believed by practitioners to be the energy in us and all around us. The key to Tai Chi is to draw upon that energy and utilize it to benefit mind and body.

I first took lessons in Tai Chi Qong with my mom and sister in the early 90s. My 85 year-old mom and I are still practicing!

A gentle stretch incorporating balance

Seeing the core strength, improved balance and flexibility it gave us, I began to apply some of the stretches and movements to my physical therapy practice with patients, when appropriate. I found that my patients were able to increase their balance and coordination as a result of the improved core strength and flexibility. The exercises they have found most interesting involve hand-eye coordination, and those that stimulate both sides of the brain. The steps are gentle on the joints and the stretches painless. I am amazed by how many patients do so well with the one-legged stance exercises! It took me a while to stay upright and master those!

Tai Chi can benefit people who have suffered strokes, have heart disease, have had joint replacements or have neuromuscular disorders like multiple sclerosis. It is also gentle enough for those with osteoarthritis, rheumatoid arthritis, lupus and fibromyalgia. People who have had falls can gain balance and leg strength. Those deconditioned from illness and surgery certainly can benefit from even a little Tai Chi.

Four in the morning comes early, but my body always thanks me!

~ Marion C. Howell, MS PT