Folks, you know I’m a long-time believer in intermittent fasting for longevity, autophagy, mental clarity, fitness performance, metabolic health, and more. I’m excited that Dr. Jason Fung has stopped by the blog today to share a bit about common fasting mistakes. Enjoy!
So, you’ve decided to add some fasting to your lifestyle. Excellent. No matter how much you have (or haven’t) read on the topic, you’re likely to find aspects of fasting to be challenging or even frustrating. It can be hard to stay on track when you’re feeling hungry, irritable and not really noticing any changes.
It’ll become tremendously easier once you begin to experience the health benefits of fasting, but we all know it takes a little while for that to happen. Benefits like mental clarity and improved energy will show up sooner than significant weight loss. Plus, the benefits you experience will depend on what kind of fast you’re doing and how well you stick to it.
But if you’re making fasting mistakes, you might never accomplish the benefits you were hoping for. . Before you throw in the towel, I want to help you identify some possible fasting pitfalls you might not be aware of and also help you avoid them. Plus, don’t miss the Number One reason fasts fail, shared at the end of this article.
1. You’re Snacking or “Grazing”
Look, the entire purpose of a fast is to contain your eating within certain windows of time. Snacking or “grazing” all day long is basically the opposite of fasting, so stop thinking that you can get away with it. Fasting is “on” or “off”—there is no gray area. Even having “just a bite,” no matter how healthy or how little, will almost invariably kick your body out of fasting mode and will interfere with the healing process responsible for fasting’s many benefits. It also creates a situation where your body is producing insulin all day long. Bad idea.
Avoid grazing by putting snacks and food out of sight. The phrase “out of sight, out of mind” really applies here. You’ll be amazed how much easier it is to bypass snacking when the food isn’t sitting right in front of you. If you snack out of habit, get creative and find new, non-food based habits. If your snacking comes from genuine hunger, you may need to re-evaluate the meals you eat during your eating window. Make sure you’re getting enough healthy, unsaturated fats with each meal as these will keep you satiated for longer.
2. You Aren’t Drinking Enough Water
This is not only a common fasting mistake, but a mistake most people make no matter what their diet is. Drinking a minimum of eight glasses of water daily is essential to staying hydrated and healthy. Some signs that you aren’t drinking enough water include dizziness and lightheadedness, feeling tired, or constipation.
Even worse, when you don’t drink enough water, your brain may try to trick you into thinking that you’re hungry, so you get the vitamins and minerals you’re lacking. Minerals like potassium and magnesium are essential to your brain health. So don’t be surprised next time you feel hungry but find that drinking a glass of water makes the appetite disappear. Various kinds of tea are also a satisfying way to hydrate, or try some bone broth if you’re truly struggling.
3. You Aren’t Consuming Enough Salts
Speaking of vitamins and minerals, appropriate salt intake is vital to your health. Now, when I say “salt,” I’m not talking about the kind you put in a shaker. I’m talking about electrolytes, which are essential to your diet. Sodium (Na), which is also commonly known as table salt, is one of these electrolytes, along with potassium (K), magnesium (Mg), calcium (Ca), and chloride (Cl).
How can you tell if you’re low on electrolytes? Some symptoms of electrolyte deficiency are anxiety, irritability, trouble sleeping, muscle spasms, fatigue, digestive issues, and dizziness. If these are the kinds of symptoms you experience during your fast, lack of electrolytes could be the answer. Try taking some pink Himalayan rock salt and placing it under your tongue to dissolve. You can also try drinking some pickle juice — just make sure it’s from high-quality natural pickles and not the kind made with sugar.
4. You’re Eating Right Before You Go To Sleep
Your body needs time to digest all the food from your last meal before you go to sleep. If you’ve scheduled your eating window to happen right before bedtime, your body will be taking all the time you’ve allotted to rest to digest instead. That takes energy, and instead of waking up feeling restored and ready to take on the day, you’ll just feel tired.
When you’re following a fasting plan, a seven-hour window is an ideal amount of time to leave between your last meal and when you go to sleep. Even three or four hours is enough to make a difference. Unfortunately, with crazy work schedules and early mornings, a lot of people aren’t able to stick to that three- or four-hour window. It’s more like get home, eat dinner, and go straight to bed. If this is you, the next best thing is to eat a light meal, like salad, and avoid a meal filled with carbohydrates and protein.
5. You’re Eating Too Much of Some Food Groups
When we cut certain foods from our diet, especially carbs, it’s easy to rely on other food groups, like nuts and dairy. They’re readily available and a staple of most diets.
Nuts are a low-carb, healthy fat option, but only in small amounts. They’re great to add to fruit or veggie salads, and they’re easy to grab a handful of when you need a quick snack. But those quick snacks can add up, especially on top of eating full meals. Nuts are high in good fat, low in carbs, and are a good source of protein, but too much protein can be detrimental to your fast. Excess protein that your body doesn’t need is converted to glucose and stored as fat. If you’re fasting to lose weight, this is the exact opposite of what you want.
Dairy, the other easy food group that too many people defect to, can cause inflammation, upset stomach, bloating, gas, and other kinds of discomfort. If this is a pattern you’ve noticed with your own health and eating habits, try cutting out dairy for a few weeks and see if these symptoms improve. If you haven’t noticed these symptoms, be more mindful of your eating habits and track how you feel after eating dairy.
6. You Aren’t Eating Enough of Certain Food Groups
As easy as it is to eat too much of one food group, it’s equally easy to not get enough of another. Just because you can eat “whatever” you want during your eating window doesn’t mean you should. Empty calories and junk food are momentarily satisfying, but they don’t fuel your body. Eating the right foods provides your body with the nutrients it needs to thrive throughout the day; these foods will also keep you feeling fuller, longer.
Vegetables are one of the best food groups to keep you nourished and thriving. They’re low calorie and they provide different vitamins and minerals like potassium, fiber, folate, vitamin A, and vitamin C. Fruits are also healthy, but don’t overdo it, as most are high in sugar. Fruit juices typically have added sugar as well. Naturally flavored drinks and teas are the healthiest option. Nuts are high in fat and a good source of protein, as are eggs. Refined carbohydrates and sugars are highly unnecessary for your body and if you’re going to include them in your meals, there should be very little.
7. You’re Pushing Your Body Too Hard
Did you dive off the deep end and go from zero fasting to attempting 24-hr fasts every other day? Back up and take a more moderate approach first. Don’t expect fasting to be easy right away. Not only will your body need time to adjust, but your mind will, too. If you’ve been accustomed to three square meals a day, plus snacks and calorie-filled drinks, your body has gotten used to this routine.
Your body needs time to adapt. First it burns through stored sugar and then it will start burning body fat for energy. Start slow and get a feeling for this new practice. You can start with a twelve-hour fasting period and twelve-hour eating window. When eight hours of that fast are during your sleeping hours, this window is relatively easy. Once you’ve become accustomed to this schedule, you can reduce your eating window to ten hours. Continue decreasing your eating window by two hours every one to two weeks, until you’ve hit the fasting period you want.
8. You Have the Wrong Mindset
Fasting provides your body with everything it needs to thrive, but without the right mindset, you’re bound to fail. Focusing on the negative, like not being allowed to eat certain foods or at certain times, will easily spiral into other negative self-talk. The harder you are on yourself, the more difficult it is to achieve success.
Rather than thinking about how hard the fast is, focus on the positive that will come out of it. Fasting allows your body to heal. Fasting can help you lose weight. You’ll feel more energized and have a clearer mind. Whatever the reason you’ve chosen to fast, focus on that. Fasting with a friend, family member, partner, or online community is another way to hold yourself accountable and can be very helpful.
9. You’re Too Stressed
When you’re stressed, your body releases a hormone called cortisol. Cortisol is problematic when fasting because it can prompt your body to break down muscle tissue instead of fat. When fasting, your body should tap into stored body fat and preserve your healthy muscle tissue.
If you’re stressed on occasion, this shouldn’t cause much of a problem. But if you’re chronically stressed, that constant release of cortisol can lead to a breakdown of muscle tissue.
Not sure if you’re stressed? Here are some symptoms:
- Teeth grinding
- Muscle tension
- Digestive problems
- Trouble concentrating
Alleviate stress with deep breathing, positive visualization, an epsom salt bath, and stress-relieving teas. If you can, take some time off from work. If you’re an outdoorsy person, relax in nature.
10. You’re Inactive
Being inactive is one of the biggest mistakes people make during their fast. If you aren’t eating, you should rest and save your energy, right? Wrong. Exercise is a great way to improve your fasting. Activity increases fat burning and boosts circulation. Going outside and getting some sunlight and fresh air can improve your mood, making you more likely to stick to your fast. Movement generally makes people feel better than sitting on the couch inside all day; being inactive makes you cold, tired, and unfocused.
Since a lot of people work sedentary jobs that tie them to a desk all day, exercise isn’t a convenient way to stay active. But taking a short walk or stretching are two easy ways to get your blood flowing throughout the day.
Fasting shouldn’t be synonymous with suffering. If you’re feeling deprived during your fast, be sure that you aren’t making any of the above fasting mistakes. Ease yourself into your fast, stick with it, and enjoy the results when they come with time.
But there’s one more—in fact, the number one reason fasts fail….
Can you guess what it is?
***Giving Into Cravings
Which is why I want to tell you about my new favorite secret weapon for staying fasted longer and with less difficulty: Pique Fasting Teas. Why tea? The combination of catechins and caffeine gives you a higher chance of experiencing tangible benefits from fasting. It suppresses hunger cravings, boosts calorie burn and supports malabsorption of unhealthy fats and sugars.
These Fasting Teas include ingredients targeted at maximizing the fasting experience:
1) Organic highest ceremonial grade matcha, which increases levels of l-theanine to calm and tide you through your fasts with ease. 2) Organic peppermint, which is a natural appetite suppressant with calming properties. 3) Proprietary blend of high catechin green Tea Crystals, which regulate the hunger hormone ghrelin and increase thermogenesis (burning fat for fuel). This helps you to stay fasted and see quicker results. 4) Additional plant ingredients including ginger and citrus peel to support digestion and enhance autophagy.
As with all of Pique’s teas, you can rest assured these are pure and Triple Toxin Screened for pesticides, heavy metals and toxic mold. For a limited time only, if you order through the Mark’s Daily Apple link, you can get up to 8% off and free shipping (U.S. only).
Thanks again to Dr. Jason Fung for today’s post. Have questions on fasting protocols or missteps? Share them below, everybody, and have a great day.
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Biological systems are self-maintaining. They have to be. We don’t have maintenance workers, mechanics, troubleshooters that can “take a look inside” and make sure everything’s running smoothly. Doctors perform a kind of biological maintenance, but even they are working blind from the outside.
No, for life to sustain itself, it has to perform automatic maintenance work on its cells, tissues, organs, and biological processes. One of the most important types of biological maintenance is a process called autophagy.
Autophagy: the word comes from the Greek for “self-eating,” and that’s a very accurate description: Autophagy is when a cell consumes the parts of itself that are damaged or malfunctioning. Lysosomes—members of the innate immune system that also degrade pathogens—degrade the damaged cellular material, making it available for energy and other metabolites. It’s cellular pruning, and it’s an important part of staving off the worst parts of the aging process.
In study after study, we find that impairment to or reductions of normal levels of autophagy are linked to almost every age-related degenerative disease and malady you can imagine.
- Cancer: Autophagy can inhibit the establishment of cancer by removing malfunctioning cellular material before it becomes problematic. Once cancer is established, however, autophagy can enhance tumor growth.
- Diabetes: Impaired autophagy enables the progression from obesity to diabetes via pancreatic beta cell degradation and insulin resistance. Impaired autophagy also accompanies the serious complications related to diabetes, like kidney disease and heart failure.
- Heart disease: Autophagy plays an important role in all aspects of heart health.
- Osteoporosis: Both human and animal studies indicate that autophagy dysfunction precedes osteoporosis.
- Alzheimer’s disease: Early stage Alzheimer’s disease is linked to deficits in autophagy.
- Muscle loss: Autophagy preserves muscle tissue; loss of autophagy begins the process of age-related muscle atrophy.
Okay, so autophagy is rather important. It’s fundamental to health.
But how does autophagy happen?
The way it’s supposed to happen is this:
Humans traditionally and historically lived in a very different food environment. Traditionally and historically, humans were feasters and fasters. While I don’t think our paleolithic ancestors were miserable, wretched, perpetually starving creatures scuttling from one rare meal to the next—the fossil records show incredibly robust remains, with powerful bones and healthy teeth and little sign of nutritional deficits—they also couldn’t stroll down to the local Whole Foods for a cart full of ingredients. Going without food from time to time was a fundamental aspect of human ancestral life.
They worked for their food. I don’t mean “sat in a cubicle to get a paycheck to spend on groceries.” I mean they expended calories to obtain food. They hunted—and sometimes came back empty handed. They dug and climbed and rooted around and gathered. They walked, ran, stalked, jumped, lifted. Movement was a necessity.
In short, they experienced energy deficits on a regular basis. And energy deficits, particularly sustained energy deficits, are the primary triggers for autophagy. Without energy deficits, you remain in fed mode and never quite hit the fasted mode required for autophagy.
Now compare that ancestral food environment to the modern food environment:
Almost no one goes hungry. Food is cheap and plentiful, with the tastiest and most calorie-rich stuff tending to be the cheapest and most widely available.
Few people have to physically work for their food. We drive to the store and walk a couple hundred steps, hand over some money, and—BOOM—obtain thirty thousand calories, just like that. Or someone comes to our house and delivers the food directly.
We eat all the time. Unless you set out to do it, chances are you’ll be grazing, snacking, and nibbling throughout the day. We’re in a perpetually fed state.
The average person in a modern society eating a modern industrial diet rarely goes long enough without eating something to trigger autophagy. Nor are they expending enough energy to create an energy deficit from the other end—the output. It’s understandable. If our ancestors were thrust into our current situation, many would fall all over themselves to take advantage of the modern food environment. But that doesn’t make it desirable, or good for you. It just means that figuring out how to trigger autophagy becomes that much more vital for modern humans.
Here are 7 ways to induce autophagy with regular lifestyle choices.
There’s no better way to quickly and reliably induce a large energy deficit than not eating anything at all. There are no definitive studies identifying “optimal” fasting guidelines for autophagy in humans. Longer fasts probably allow deeper levels of autophagy, but shorter fasts are no slouch.
2) Get Keto-Adapted
When you’re keto- and fat-adapted, it takes you less time to hit serious autophagy upon commencing a fast. You’re already halfway there.
3) Train Regularly
With exercise-related autophagy, the biggest effects are seen with lifelong training, not acute. In mice, for example, the mice who are subjected to lifelong exercise see the most autophagy-related benefits. In people, those who have played soccer (football) for their entire lives have far more autophagy-related markers of gene activity than people of the same age who have not trained their whole lives.
4) Train Hard
In studies of acute exercise-induced autophagy, the intensity of the exercise is the biggest predictor of autophagy—even more than whether the athletes are in the fed or fasted state.
5) Drink Coffee
At least in mice, both caffeinated and decaffeinated coffee induce autophagy in the liver, muscle tissue, and heart. This effect persists even when the coffee is given alongside ad libitum food. These mice didn’t have to fast for the coffee to induce autophagy.
Certain nutrients can trigger autophagy, too….
6) Eat Turmeric
Curcumin, the primary phytonutrient in turmeric, is especially effective at inducing autophagy in the mitochondria (mitophagy).
7) Consume Extra Virgin Olive Oil
The anticancer potential of its main antioxidant, oleuropein, likely occurs via autophagy.
Disclaimer: The autophagy/nutrient literature is anything but definitive. Most studies take place in test tube settings, not living humans. Eating some turmeric probably won’t flip a switch and trigger autophagy right away, but it won’t hurt.
Autophagy is a long game.
This can’t be underscored enough: Autophagy is a lifelong pursuit attained by regular doses of exercise and not overeating every time you sit down to a meal. Staying so ketotic your pee tests look like a Prince album cover, doing epic 7-day fasts every month, fasting every other day, making sure you end every day with fully depleted liver glycogen—while these strategies might be “effective,” obsessing over their measures to hit some “optimal” level of constant autophagy isn’t the point and is likely to activate or trigger neurotic behavior.
Besides, we don’t know what “optimal autophagy” looks like. Autophagy isn’t easy to measure in live humans. You can’t order an “autophagy test” from your doc. We don’t even know if more autophagy is necessarily better. There’s the fact that unchecked autophagy can actually increase existing cancer in some cases. There’s the fact that too much autophagy in the wrong place might be bad. We just don’t know very much. Autophagy is important. It’s good to have some happening. That’s what we have to go on.
Putting These Tips Into Practice
Autophagy happens largely when you just live a healthy lifestyle. Get some exercise and daily activity. Go hard every now and then. Sleep deeply. Recover well. Don’t eat carbohydrates you don’t need and haven’t earned (and I don’t just mean “earned through glycogen depleting-exercise”). Reach ketosis sometimes. Don’t eat more food than you need. Drink coffee, even decaf.
All those caveats aside, I see the utility in doing a big “autophagy session” a few times a year. Here’s how mine looks:
- Do a big training session incorporating strength training and sprints. Lots of intense bursts. This will trigger autophagy.
- Fast for two or three days. This will push autophagy even further.
- Stay busy throughout the fast. Take as many walks as possible. This will really ramp up the fat burning and get you quickly into ketosis, another autophagy trigger.
- Drink coffee throughout the fast. Coffee is a nice boost to autophagy. Decaf is fine.
I know people are often skeptical of using “Grok logic,” but it’s likely that most human ancestors experienced similar “perfect storms” of deprivation-induced autophagy on occasion throughout the year. You track an animal for a couple days and come up short, or it takes that long to make the kill. You nibble on various stimulants plucked from the land along the way. You walk a ton and sprint some, then lift heavy. And finally, maybe, you get to eat.
If you find yourself aging well, you’re on the right track. If you’re not progressing from obesity to diabetes, you’re good to go. If you’re maintaining and even building your muscle despite qualifying for the blue plate special, you’ve probably dipping into the autophagy pathway. If you’re thinking clearly, I wouldn’t worry. Obviously, we can’t really see what’s happening on the inside. But if everything you can verify is going well, keep it up.
That’s it for today, folks. If you have any more questions about autophagy, leave them down below and I’ll try to get to all of them in future posts.
Thanks for reading!
Yang ZJ, Chee CE, Huang S, Sinicrope FA. The role of autophagy in cancer: therapeutic implications. Mol Cancer Ther. 2011;10(9):1533-41.
Barlow AD, Thomas DC. Autophagy in diabetes: ?-cell dysfunction, insulin resistance, and complications. DNA Cell Biol. 2015;34(4):252-60.
Sasaki Y, Ikeda Y, Iwabayashi M, Akasaki Y, Ohishi M. The Impact of Autophagy on Cardiovascular Senescence and Diseases. Int Heart J. 2017;58(5):666-673.
Florencio-silva R, Sasso GR, Simões MJ, et al. Osteoporosis and autophagy: What is the relationship?. Rev Assoc Med Bras (1992). 2017;63(2):173-179.
Li Q, Liu Y, Sun M. Autophagy and Alzheimer’s Disease. Cell Mol Neurobiol. 2017;37(3):377-388.
Jiao J, Demontis F. Skeletal muscle autophagy and its role in sarcopenia and organismal aging. Curr Opin Pharmacol. 2017;34:1-6.
Schwalm C, Jamart C, Benoit N, et al. Activation of autophagy in human skeletal muscle is dependent on exercise intensity and AMPK activation. FASEB J. 2015;29(8):3515-26.
De oliveira MR, Jardim FR, Setzer WN, Nabavi SM, Nabavi SF. Curcumin, mitochondrial biogenesis, and mitophagy: Exploring recent data and indicating future needs. Biotechnol Adv. 2016;34(5):813-826.
Przychodzen P, Wyszkowska R, Gorzynik-debicka M, Kostrzewa T, Kuban-jankowska A, Gorska-ponikowska M. Anticancer Potential of Oleuropein, the Polyphenol of Olive Oil, With 2-Methoxyestradiol, Separately or in Combination, in Human Osteosarcoma Cells. Anticancer Res. 2019;39(3):1243-1251.
The post The Definitive Guide To Autophagy (and 7 Ways To Induce It) appeared first on Mark’s Daily Apple.
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Thanks for giving Jessica Gouthro from Paleohacks such a warm reception last week. I’m glad you found her “13 Ways To Move More At Work” useful. She’s joining us again today to offer tips for those who are looking to ease joint pain. Enjoy!
It sounds counterintuitive, but it’s true: one of the best ways to ease joint pain is to exercise!
Whether you’re feeling aches and pains in your elbows or your lower back and hips, the key to managing and preventing joint and muscle pain is to exercise in the right way. If you have existing pain or joint discomfort, then you need to keep your workouts low-impact, but that doesn’t have to mean easy or ineffective.
You can keep reduce impact and lower your risk of injury by performing exercises that place less stress on the joints.
Some of the most popular low-impact workout options include:
- Elliptical cardio
- Incline walking
- Controlled light-resistance weight training
- Stretching and yoga
Aside from keeping your workouts low-impact, you can also start doing simple exercises to ease discomfort in specific parts of your body, like these 13 stretches for lower back pain or these 13 feel-good hip openers.
Try all 10 of the following exercises to relieve different forms of joint pain. You’ll need a chair, a small hand towel, a light dumbbell, and a resistance band for some of these moves. Remember your favorites and include them in your workouts anytime you feel discomfort in your joints.
1) “Wring the Towel” Wrist Stretch | 10 reps
Roll up a small towel and grab the ends with both hands.
Hold your arms out in front of you with palms facing down.
Slowly and with control, pretend you are wringing water out of the towel. Tilt one wrist up and the other wrist down at the same time, then alternate sides.
Continue wringing the towel in both directions for 10 full reps.
2) Dumbbell Wrist Curl | 10 reps per side
Sit on a chair or bench. Hold a light dumbbell in one hand and rest your elbow on your knee.
Keeping your arm still, exhale to flex your forearm and bend your wrist towards you to curl the dumbbell up.
Inhale to relax your wrist back to the starting position. .
Repeat for 10 slow and controlled reps, focusing on full range of motion with your wrist. Then switch sides.
3) Elbow Compression with Small Towel | 3 reps per side
Hold your arm out long. Roll up a small towel and place it right over your elbow.
Make a fist and curl your arm towards you, bending your elbow all the way closed on the towel. Aim to reach your knuckles to your shoulder.
Use your other hand to gently press inward on the back of your wrist to increase the compression. Breathe deeply as you hold for five seconds, then switch sides.
Complete three reps per side.
4) Narrow Grip Wall Press Tricep Extension | 10 reps
Place your palms flat on the wall at your chest height.
Step back a few feet so your body is at a slight angle. Ensure that your palms are flush against the wall.
Bend your elbows to lower your body towards the wall, keeping your elbows pointing straight down.
Stop when your elbows are about 3 inches from the wall and press back to straighten arms, flexing your elbows all the way.
Continue for 10 reps.
Tip: For a greater challenge, you can try this exercise with palms on a bench.
5) Hip and Low Back Compression Stretch | 3 reps per side
Lay flat on your back with your knees bent, feet flat on the ground.
Lift one knee towards your chest, using your hands to pull it in towards you. Actively work to ground your hips.
Take five deep breaths, then switch and do the same on the other side.
Continue alternating sides to complete three reps per side.
6) Pelvic Tilt | 10 reps
Stand with your feet shoulder-width apart.
Hinge at the hips and place your palms on your knees.
Lift your sitting bones and tilt your pelvis forward to create an arch in your lower back and stretch your hamstrings. Keep your neck in neutral and shoulders relaxed. Hold for a few breaths.
Next, round your lower spine and tuck your pelvis under to form a round shape. Hold for a few breaths.
Alternate between tilting forward and back for 10 reps, holding each pose as long as you like to relieve the pain and pressure in your low back and hips.
7) Single Leg Toe Touch | 10 reps per side
Stand on one foot and look down towards the ground to get balanced.
Hinge at the hips as you raise your back leg behind you, reaching your fingers toward the toes of the standing leg. Get as parallel to the ground as you can.
Slowly rise back up with control.
Repeat 10 reps on one side, then switch to the other side.
8) Glute Kicks | 10 reps
Kneel down on all fours and flex your right foot. Keep your left foot relaxed.
Lift your right leg up to form a straight line from your right knee to shoulders, with your right foot facing the ceiling.
Hold at the top for three seconds while engaging your glutes, then relax your knee back to the ground.
Repeat on the same side for 10 reps, then switch to the other side.
9) Resistance Band Knee Extension with a Chair | 10 reps per side
Loop a resistance band around one leg of a chair, and place the other end of the band behind one of your knees.
Grab the seat of the chair with your hands. Then step back until you feel a good amount of tension on the band.
Your banded leg should be directly below your hips.
Straighten your leg fully, resisting the tension on the band.
Then relax the knee. Keep your foot flat on the ground the entire time.
Repeat for 10 reps, then switch legs.
10) Isometric Quad Flex | 6 reps per side
Sit on the ground and place a rolled up bath towel under your right knee.
Place your hands on the ground behind you for support and sit up tall.
Flex your right leg to lift your heel off the ground. You should feel all the muscles surrounding your knee fire up.
Hold this flex for five full seconds, then relax.
Repeat six times on this side, then switch to the left leg.
Tip: For a challenge, increase the number of reps or increase each hold to eight seconds.
Revisit these helpful exercises anytime you feel joint pain or discomfort. As always, be smart about working through an injury. If your body is telling you to rest, do it. When the time is right, apply these gentle exercises to help you get stronger and feel better.
Thanks again to Jessica Gouthro for these tips and to Brad Gouthro for demonstrating them. Questions or comments about exercises or treatment for joint pain? Share them below, and thanks for stopping by.
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I’ll start with the bad news: There are no vegetarian collagen sources. Every collagen supplement you see on the shelf came from a living organism. Though somewhere down the line someone will probably grow legitimate collagen in a lab setting, it’s not available today or for the foreseeable future.
Now, some good news: Vegans and vegetarians probably need less dietary collagen than the average meat eater or Primal eater because a major reason omnivores need collagen is to balance out all the muscle meat we eat. When we metabolize methionine, an amino acid found abundantly in muscle meat, we burn through glycine, an amino acid found abundantly in collagen. If you’re not eating muscle meat, you don’t need as much glycine to balance out your diet, but it’s still a dietary necessity.
Collagen isn’t just about “balancing out meat intake.” It’s the best source of a conditionally essential amino acid known as glycine. We only make about 3 grams of glycine a day. That’s not nearly enough. The human body requires at least 10 grams per day for basic metabolic processes, so we’re looking at an average daily deficit of 7 grams that we need to make up for through diet. And in disease states that disrupt glycine synthesis, like rheumatoid arthritis, we need even more.
What About Marine Collagen?
Okay, but eating a product made from a cuddly cow or an intelligent pig is off limits for most vegetarians. What about marine collagen—collagen derived from fish bones, scales, and skin?
Back about twenty years ago, “vegetarians” often ate fish. A number of them still exist out in the wild, people who for one reason or another avoid eating land animals (including birds) but do regularly consume marine animals. If it jibes with your ethics, marine collagen is a legitimate source of collagen for vegetarians. The constituent amino acids are nearly identical to the amino acids of mammalian collagen with very similar proportions and properties.
It’s highly bioavailable, with the collagen peptides often showing up intact in the body and ready to work their magic—just like bovine or porcine collagen. In fact, if you ask many marine collagen purveyors, it’s even more bioavailable than mammalian collagen owing to its lower molecular weight.
I’m not sure that’s actually accurate, though.
According to some sources, marine collagen comes in smaller particles and is thus more bioavailable than mammalian collagen, but I haven’t seen solid evidence.
There’s this paper, which mentions increased bioavailability in a bullet point off-hand, almost as an assumption or common knowledge.
This analysis found low molecular weights in collagen derived from fish waste. Mammalian collagen generally has higher molecular weights, so that appears to be correct.
However, a very recent pro-marine collagen paper that makes a strong case for the use of marine collagen in wound repair, oral supplementation, and other medical applications does not mention increased bioavailability. It may be slightly more bioavailable—the lower the molecular weight, the more true that is—but I don’t think the effect is very meaningful. Mammalian collagen is plenty bioavailable (most efficacious studies use collagen from cows or pigs), even if it’s a few dozen kilodaltons heavier.
But even if marine collagen isn’t particularly superior to mammal collagen, it is equally beneficial.
For skin health: Fish collagen improves hydration, elasticity, and wrinkling in humans who eat it. And again.
For metabolism: Fish collagen improves glucose and lipid metabolism in type 2 diabetics. HDL and insulin sensitivity go up, triglycerides and LDL go down.
And although fish collagen hasn’t been studied in the treatment of joint pain, if it’s anything like other types of collagen, it will help there too.
What Are Strict Vegetarian Options?
What if you absolutely won’t eat collagen from marine sources? Is there anything you can do as a vegetarian to make up for it?
Make Your Own
You could cobble together your own facsimile of collagen by making an amino acid mixture. Glycine, proline, and arginine don’t cover all the amino acids present in collagen, but they’re widely available and hit the major ones.
Still, eating the amino acids that make up collagen separately doesn’t have the same effect on those collagenous tissues as eating them together in a collagenous matrix. One reason is that the collagen matrix can survive digestion more or less intact, giving it different biological properties and effects.
In one study, rats with osteoporosis ate collagen hydrolysate that scientists had marked with a radioactive signature to allow them to track its course through the body. It survived the digestive tract intact, made it into the blood, and accumulate in the kidneys. By day 14, the rats’ thigh bones had gotten stronger and denser with more organic matter and less water content.
Another study found similar results, this time for cartilage of the knee. Mice who ate radioactive collagen hydrolysate showed increased radioactivity in the knee joint.
In both cases, the collagen remained more or less intact. A blend of the isolated amino acids would not. The fact is that collagen is more than glycine. When you feed people collagen derived from pork skin, chicken feet, and cartilage, many different collagenous peptides appear in the blood. You don’t get any of those from isolated glycine.
That’s not to say it’s pointless. Pure glycine can be a helpful supplement, used in several studies to improve multiple markers of sleep quality. Just don’t expect it to have the same effect as full-blown collagen.
Get Adequate Vitamin C
Acute scurvy, caused by absolute vitamin C deficiency, triggers the dissolution of your connective tissue throughout the body. Teeth fall out, no longer held in by gums. Wounds don’t heal, your body unable to lay down new collagen.
Vegetarians usually don’t have any issues getting adequate vitamin C.
Get Adequate Copper
Copper is a necessary cofactor in the production of collagen. Studies show that you can control the production of collagen simply by providing or withholding copper.
The best vegetarian source of copper is probably dark chocolate, the darker and more bitter the better.
Get Adequate Lysine
Lysine is another amino acid that’s necessary for the production of collagen.
True vegetarian collagen doesn’t exist. Strict vegetarians will balk. But if you can bend the rules a bit, realize that making marine collagen out of fins and scales and bones is far less wasteful than just throwing it away, and look at the benefits with an objective eye, you’ll be pleasantly surprised. Even if you don’t end up using marine collagen, at least you have a few tools for getting many of the benefits with quick shortcuts and optimizing your own production of collagen.
Have you ever tried marine collagen? If you’re a vegetarian, would you consider it?
Thanks for reading, everyone. Take care and be well.
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Welcome to Friday’s For The Love of Food, Summer Tomato’s weekly link roundup. A few extra this week since I missed last week.
This week how to keep your heart 30 yrs younger, hunger induces risky eating behavior, and climate change makes oysters more dangerous.
Next week’s Mindful Meal Challenge will start again on Monday. Sign up now to join us!
Too busy to read them all? Try this awesome free speed reading app to read at 300+ wpm. So neat!
Links of the week
- Two Surprising Ways to Make Your Holidays Less Stressful – Maybe the best advice you’ll read all season. (Greater Good Magazine)
- What We Know About Diet and Weight Loss – There is actually some stuff we know, even if there’s still a lot we don’t. (NY Times)
- Exercise Wins: Fit Seniors Can Have Hearts That Look 30 Years Younger – Exercise is so good in so many ways. Don’t find time, make time to do it. (NPR)
- Is Aerobic Exercise the Key to Successful Aging? – Keep in mind this is only one reason. Strength training and has a separate set of benefits you also need. (NY Times)
- What a Hungry Snail Reveals About YourGrocery Store Breakdowns – This must explain why dieters can so frequently be seen eating protein bars. (NY Times)
- How Pink Salt Took Over Millennial Kitchens – This article really annoys me since it overlooks the one reason I stopped cooking with sea salt and switched to Himalayan salts a few years ago: almost all sea salts contain nanoparticles of plastic, while the ancient salt reserves do not. (The Atlantic)
- As Climate Changes, Is Eating Raw Oysters Getting Riskier? – We touch on this in my recent podcast with Bill Marler about food safety. Personally I don’t eat Gulf oysters ever. (NPR)
- How to Prevent Nasty Stomach Bugs This Winter? More Bleach. – Also this. (NY Times)
- New Archive Reveals How the Food Industry Mimics Big Tobacco to Suppress Science, Shape Public Opinion – Wow. (Civil Eats)
- Already a Climate Change Leader, California Takes on Food Waste – Recent innovations in California are encouraging. (Civil Eats)
- A New Connection between the Gut and Brain – Interesting link between salt and stroke that skips the blood pressure connection. (Scientific American)
- Trump Administration Rolls Back Obama-Era Rules for School Lunches – Le sigh. (NY Times)
- Farro and White Bean Vegetable Soup – Perfect winter food. (Food Fitness Fresh Air)
What inspired you this week?
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The scientific literature is awash in correlations between a person’s health status and various biomarkers, personal characteristics, and measurements. As we hoard more and more data and develop increasingly sophisticated autonomous tools to analyze it, we’ll stumble across new connections between seemingly disparate variables. Some will be spurious, where the correlations are real but the variables don’t affect each other. Others will be useful, where the correlations indicate real causality, or at least a real relationship.
One of my favorite health markers—one that is both modifiable and a good barometer for the conditions it appears to predict—is grip strength.
The Benefits of Grip Strength
In middle-aged and elderly people, grip strength consistently predicts mortality risk from all causes, doing an even better job than blood pressure. In older disabled women, grip strength predicts all-cause mortality, even when controlling for disease status, inflammatory load, depression, nutritional status, and inactivity.
Poor grip strength is also an independent risk factor for type 2 diabetes across all ethnicities, and it can predict the presence of osteoarthritis in the knee. Among Korean adults, those with lower grip strength have a greater risk of clinical depression.
Even when hand grip strength fails to predict a disease, it still predicts the quality of life in people with the disease. The relative rate of grip strength reduction in healthy people is a good marker for the progression of general aging. Faster decline, faster aging. Slower (or no) decline, slower aging. Stronger people—as indicated by their grip strength—are simply better at navigating the physical world and maintaining independence on into old age.
Health and longevity aside, there are other real benefits to a stronger grip.
You command more respect. I don’t care how bad it sounds, because I agree. Historically, a person’s personal worth and legitimacy was judged by the quality of their handshake. Right or wrong, that’s how we’re wired. If you think you feel differently, let me know how you feel the next time you shake hands and the other person has a limp, moist hand. Who are you more likely to respect? To hire? To deem more capable? To befriend? To approach romantically? I’m not saying it’s right. I’m saying it’s simply how it is. We can’t avoid our guttural reaction to a strong—or weak—handshake. To me, that suggests we have a built-in sensitivity to grip for a very good reason.
So, how does one build grip?
10 Exercises To Build Grip Strength
Most people will get a strong-enough grip as long as they’re lifting heavy things on a consistent-enough basis.
Deadlifts are proven grip builders. Wide grip deadlifts are also good and stress your grip across slightly different angles.
2. Pullups and 3. Chinups
Both require a good grip on the bar.
Any exercise where your grip supports either your weight or an external weight (like a barbell, dumbbell, or kettlebell) is going to improve your grip strength. But there are other, more targeted movements you can try to really turn your hand into a vise. Such as:
4. Bar Hangs
This is pretty simple. Just hang from a bar (or branch, or traffic light fixture) with both hands. It’s probably the purest expression of grip strength. As it happens, it’s also a great stretch for your lats, chest, shoulders, and thoracic spine.
Aim to hit one minute. Progress to one-hand hangs if two-handers get too easy. You can use a lower bar and keep one foot on the ground for support as you transition toward a full one-handed hang.
5. Sledgehammer Work
Grab the heaviest sledgehammer you can handle and use it in a variety of ways.
If you had to pick just one sledgehammer movement to target your grip, do the bottoms up. Hold the hammer hanging down pointing toward the ground in your hand, swing it up and catch it with the head of the hammer pointing upward, and hold it there. Handle parallel to your torso, wrist straight, don’t let it fall. The lower you grip the handle, the harder your forearms (and grip) will have to work.
6. Fingertip Pushups
Most people who try fingertip pushups do them one way. They do them with straight fingers, with the palm dipping toward the ground. Like this. Those are great, but there’s another technique as well: the claw. For the claw, make a claw with your hand, like this, as if you’re trying to grab the ground. In fact, do try to grab the ground. This keeps your fingers more active, builds more strength and resilience, and prevents you from resting on your connective tissue.
These are hard for most people. They’re quite hard on the connective tissue, which often goes underutilized in the hands and forearms. Don’t just leap into full fingertip pushups—unless you know you’re able. Start on your knees, gradually pushing your knees further back to add resistance. Once they’re all the way back and you’re comfortable, then progress to full pushups.
7. Active Hands Pushups
These are similar to claw pushups, only with the palm down on the floor. Flat palm, active “claw” fingers. They are easier than fingertip pushups.
8. Farmer’s Walks
The average person these days is not carrying water pails and hay bales and feed bags back and forth across uneven ground like they did when over 30% of the population lived on farms, but the average person can quickly graduate past average by doing farmer’s walks a couple times each week. What is a farmer’s walk?
Grab two heavy weights, stand up, and walk around. They can be dumbbells, barbells, kettlebells, or trap bars. You can walk up hill, down hill, or around in circles. You can throw in some shrugs, or bookend your walks with deadlifts or swings. The point is to use your grip to carry something heavy in both hands.
9. Pinch Grips
Grasp and hold weight plates between your thumb and each finger.
10. Hammer Curls
Next time you do some curls, throw in a few sets of hammer curls. These are identical to normal bicep curls, except you hold the weights in a hammer grip, with palms facing toward each other—like how you hold and swing a hammer. Make sure to keep those wrists as straight as possible.
The thing about grip is it’s hard to work your grip without getting stronger, healthier, and faster all over. Deadlifting builds grip strength, and it also builds back, hip, glute, and torso strength. Fingertip pushups make your hands and forearms strong, but they also work your chest, triceps, abs, and shoulders. That’s why I suspect grip strength is such a good barometer for overall health, wellness, and longevity. Almost every meaningful piece of physical activity requires that you use your hands to manipulate significant amounts of weight and undergo significant amounts of stress.
For that reason, the best way to train your grip is with normal movements. Heavy deadlifts and farmer’s walks are probably more effective than spending half an hour pinch gripping with every possible thumb/finger permutation, because they offer more full-body benefits. But if you have a few extra minutes throughout your workout, throw in some of the dedicated grip training.
Your grip can handle it. The grip muscles in the hands and forearm are mostly slow-twitch fiber dominant, meaning they’re designed to go for long periods of exertion. They’re also gross movers, meaning you use them all the time for all sorts of tasks, and have been doing so for decades. To make them adapt, you need to stress the heck out of them with high weight. Train grip with high reps, heavy weights, and long durations. This is why deadlifts and farmer’s walks are so good for your grip—they force you to maintain that grip on a heavy bar or dumbbell for the entire duration of the set with little to no rest.
Oh, and pick up some Fat Gripz. These attach to dumbbells and barbells and increase the diameter of the bar, giving you less leverage when grabbing and forcing you to adapt to the new grip conditions by getting stronger.
Now, will all this grip training actually protect you from aging, type 2 diabetes, osteoarthritis, and early all-cause mortality? Maybe, maybe not.
But it—and the muscle and fitness you gain doing all these exercises—certainly doesn’t hurt.
How’s your grip? How’s your handshake? How long can you hang from a bar without letting go?
Thanks for reading, everyone. Take care, be well, and go pick up and hold some heavy stuff.
Sasaki H, Kasagi F, Yamada M, Fujita S. Grip strength predicts cause-specific mortality in middle-aged and elderly persons. Am J Med. 2007;120(4):337-42.
Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386(9990):266-73.
Rantanen T, Volpato S, Ferrucci L, Heikkinen E, Fried LP, Guralnik JM. Handgrip strength and cause-specific and total mortality in older disabled women: exploring the mechanism. J Am Geriatr Soc. 2003;51(5):636-41.
Van der kooi AL, Snijder MB, Peters RJ, Van valkengoed IG. The Association of Handgrip Strength and Type 2 Diabetes Mellitus in Six Ethnic Groups: An Analysis of the HELIUS Study. PLoS ONE. 2015;10(9):e0137739.
Wen L, Shin MH, Kang JH, et al. Association between grip strength and hand and knee radiographic osteoarthritis in Korean adults: Data from the Dong-gu study. PLoS ONE. 2017;12(11):e0185343.
Lee MR, Jung SM, Bang H, Kim HS, Kim YB. The association between muscular strength and depression in Korean adults: a cross-sectional analysis of the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI) 2014. BMC Public Health. 2018;18(1):1123.
Lee SH, Kim SJ, Han Y, Ryu YJ, Lee JH, Chang JH. Hand grip strength and chronic obstructive pulmonary disease in Korea: an analysis in KNHANES VI. Int J Chron Obstruct Pulmon Dis. 2017;12:2313-2321.
Iconaru EI, Ciucurel MM, Georgescu L, Ciucurel C. Hand grip strength as a physical biomarker of aging from the perspective of a Fibonacci mathematical modeling. BMC Geriatr. 2018;18(1):296.
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Most people chalk urinary incontinence and excessive urgency up to age. We get old, stuff stops working, we wake up to wet sheets. Cue jokes about adult diapers and investing in “Depends” futures. It’s not entirely out of line. Aging matters. There’s just more to it. Like other aspects of “aging,” incontinence and unreasonable urgency don’t just “happen.” Aging may hasten or accompany the decline, but it’s by no means inevitable, unavoidable, or unmitigated.
There are surgical treatments available, many of which involve the implantation of balloons and slings and rings and hammocks. Those are beyond the scope of this post, which will focus on exercises and other less invasive interventions and preventive measures.
What’s the Deal With Urinary Incontinence?
The most well-known type is stress incontinence. When you do anything intense enough to create pressure, such as a sneeze, a particularly boisterous laugh, a trampoline session, a power clean, or a box jump, the pressure escapes through the weakest point of your body—your slack pelvic floor muscles which support and enable bladder function. The result is inadvertent leakage.
The most common type is urgency incontinence. That’s when you can control your bladder well enough, but you feel like you have to go more frequently than you’d like. This can disrupt sleep and place you in uncomfortable situations.
There’s also prostate-related urinary incontinence. If men have incontinence, it’s usually because of prostate issues or prostate surgery altering the normal flow and function of their urinary tract. Today’s post won’t deal with this explicitly, although many of the exercises I’ll discuss that help women treat incontinence can also help men treat prostate-related incontinence. For more info on this, revisit my post on prostate health from a few weeks back.
Both stress incontinence and urgency incontinence usually have the same cause: pelvic floor dysfunction. The pelvic floor acts as a taut, supple sling of muscle and connective tissue running between the pelvis and the sacrum that supports the pelvic apparatus, including organs, joints, sex organs, bladders, bowels, and various sphincters. We use it to control our urination, our bowel movements, even our sexual functions. It’s very important.
What Goes Wrong?
It gets weak and tight and pulls the sacrum inward (the tail gets pulled toward the front of the body), interfering with urination and urinary control.
What causes pelvic floor dysfunction?
Childbirth is one potential cause, but it’s not a foregone conclusion. Women who have vaginal deliveries are more likely to display more pelvic floor dysfunction than women who have cesareans, while a more recent study found that tool-assisted vaginal delivery and episiotomy were the biggest risk factors for vaginal delivery-associated incontinence, not vaginal delivery alone. Allowing passive descent in the second stage of labor, rather than active pushing from the get-go, might also reduce the association.
Muscular atrophy of the pelvic floor muscles. The pelvis is where the magic happens. It’s where we generate power, walk, run, procreate, dance, and move. To keep it happy, healthy, and strong, we have to move. And then keep moving. Through all the various ranges of space and time and possible permutations of limbs and joints. That’s what all our muscles expect from the environment. It’s what they need. When that doesn’t happen, they atrophy—just like the other muscles.
Who Develops Incontinence?
Stress incontinence is more common among women than men. And most women with stress incontinence are older, although childbirth can increase the incidence.
Signs of Poor Pelvic Floor Function
Besides urinary incontinence and urgency incontinence—which are pretty tough to miss—what are some warning signs of poor pelvic floor function?
Low-to-no glute activity when walking. According to expert Katy Bowman, the glutes play a crucial role in pelvic floor function and incontinence prevention.
Lack of lower back curvature. This suggests your pelvis is being pulled inward due to poor glute activity and/or overly tight pelvic floor musculature.
Muscle atrophy elsewhere. If the muscle’s disappearing from your arms and legs, what do you think is happening in other areas?
What Can You Do?
Work On Your Squat
If you can’t sit in a full squat, with shins fairly vertical and heels down on the ground, you need to work on your form.
I suggest reading this old post by Kelly Starrett describing optimal squat form. He focuses on performance and strength training, but the technique applies equally to basic bodyweight squatting for pelvic floor health.
One thing to emphasize: go as low as you can without reaching “butt wink” threshold. The butt wink is when the pelvis begins rotating backward underneath the body. If you’re butt winking all over the place, you’re shortchanging your glutes and preventing them from balancing out the pelvic floor situation. Stop short of the butt wink.
Squat a Lot
You don’t have to load up the bar, although that’s a great way to build glute strength. In fact, I’d refrain from heavy squatting if you’re currently suffering from urinary incontinence, as the stress placed on that region of the body during a heavy squat can make the problem worse and cause, well, leakage.
I’m mainly talking about everyday squatting: while playing with the kids, picking up dog poop, unloading the dishwasher, brushing your teeth, cleaning the house, gardening. If you can incorporate squatting while using the bathroom, perhaps with a Squatty Potty or similar product, that’s even better. Katy Bowman recommends women squat to pee in the shower as an integral part of her therapy for pelvic floor disorder.
Squat To Use the Toilet (or At Least Get Your Feet Up)
I wrote an entire post almost ten years ago exploring the virtues of squatting to poop. Not only does it improve symptoms in hemorrhoid sufferers, reduce straining, and alleviate constipation, but squatting to poop turns out to relieve a lot of excessive pressure on the pelvic floor musculature.
Not everyone’s going to hoist themselves up over the toilet standing on a stack of thick books, or go all out and build a Southeast Asian-style squat toilet in their bathroom, or even get the Squatty Potty. It’s probably the best way to do it—and it’s certainly the most evolutionarily concordant way to poop—but it’s not totally necessary. What matters most is getting those feet up and those knees above your hips. If you can achieve this by placing your feet on a stool (not that kind of stool) as you sit on the toilet, it should do the trick.
Take a Walk and Feel Yourself Up
Next time you walk, rest your palms on the upper swell of your butt cheeks. Every time you step through, you should feel your glutes contract. If they contract, awesome. You’re unconsciously using your glutes to propel yourself forward. If they don’t, you’ll have to train them to contract when you walk.
Do this by going for a ten minute walk (minimum) every single day while feeling your glutes. Consciously contract them enough and feel yourself up enough and the resultant biofeedback will make glute activation a passive behavior, like breathing. Eventually you’ll start doing it without thinking. That’s the goal.
The classic therapy for pelvic floor disorder is to train the pelvic floor muscles directly using kegels. This is the muscle you contract to stop yourself from peeing midstream. “Doing kegels” means contracting and releasing that muscle for sets and reps. A common recommendation is to hold for ten seconds, release for ten seconds, repeated throughout the day. Waiting in line? Kegels. Eating dinner? Do some kegels. Remember that man at the DMV last week who would randomly tense up and start sweating as you both waited for your number? He was probably doing kegels.
Consider Katy Bowman’s take on the subject. She thinks kegels by themselves make the problem worse by creating a tight but ultimately weakened pelvic floor muscle that pulls the sacrum further inward. Combine that with weak or underactive glutes that should be balancing the anterior pull on the sacrum but don’t and you end up with rising pelvic floor dysfunction and incontinence. She recommends doing kegels while in the squat position to ensure that the glutes are engaged and all the other contributing muscles are in balance.
Do More Than Kegels
The bad news is that we don’t have controlled trials of Katy Bowman’s protocols with deep squats and frequent daily movement and going barefoot over varied surfaces and squat toilets. We mostly just have basic “pelvic floor exercises,” which usually just mean “kegels.” The good news is that even these suboptimal exercise therapies seem to work on anyone with incontinence, whether they’re just coming off a pregnancy, a 70th birthday, or a prostate procedure. Young, old, middle-aged, male, female—exercise works.
Actually, we do have one small study that suggests kegels will work much better if you balance them out with exercises that target the glutes and hips. In the study, women suffering from urinary incontinence were split into two treatment groups. One group did pelvic floor muscle exercises (kegels). The other group did pelvic floor muscle exercises, plus exercises to strengthen the hip adductors, the glute medius, and glute maximus. Both groups improved symptoms, but the group that did the combo exercises had better results.
For hip adduction, you can use that hip adduction machine where you straddle the chair with legs spread and bring your knees together against resistance. Another option is to use resistance bands. Attach one end of the band to a secure structure and the other to your ankle. Stand with legs spread, then bring the banded leg inward toward the unbanded leg; you should feel it in your inner thigh. Do this for both legs.
For glutes, you have many options. Glute bridges, hip thrusts, squats, deadlifts, lunges, resistance band glute kickbacks.
If you want to get deep into this subject and really learn the optimal exercises for pelvic floor dysfunction, I’d pick up a copy of Katy’s Down There For Women.
Get Strong and Stay Strong
One of the strongest predictors of urinary incontinence is physical frailty. The more frail—weak, fragile, prone to falling, unable to handle stairs, unsteady on one’s feet—the man or woman, the more likely they are to suffer from urinary incontinence. This mostly comes down to muscle atrophy; the frail tend to have low muscle mass all over, including the pelvic floor.
The best option is to never get frail in the first place. If you’re younger and in shape, keep training and moving. Don’t lose it. If you’re younger and trending frail, get training and moving. Don’t squander the time you have. It goes quickly. If you’re older and frail, you have to start today. Fixing this doesn’t happen overnight. Being frail makes it harder to do the things necessary to get strong, but that doesn’t absolve you of the responsibility.
The Bottom Line
None of this stuff is a guarantee against incontinence. Guarantees don’t really exist in life. But I’d definitely argue that anyone who employs all the tips and advice mentioned in today’s post will have a better shot at maintaining bladder control than their doppelganger in some parallel universe who never tries anything—the earlier the better.
If you have any experience with urinary incontinence, let us know in the comments down below. What worked? What didn’t? What worked for a while, then stopped?
Thanks for reading—and sharing here. Happy Halloween, everybody.
Bernstein IT. The pelvic floor muscles: muscle thickness in healthy and urinary-incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. Estrogen receptor studies. Neurourol Urodyn. 1997;16(4):237-75.
De araujo CC, Coelho SA, Stahlschmidt P, Juliato CRT. Does vaginal delivery cause more damage to the pelvic floor than cesarean section as determined by 3D ultrasound evaluation? A systematic review. Int Urogynecol J. 2018;29(5):639-645.
Kokabi R, Yazdanpanah D. Effects of delivery mode and sociodemographic factors on postpartum stress urinary incontinency in primipara women: A prospective cohort study. J Chin Med Assoc. 2017;
Handa VL, Harris TA, Ostergard DR. Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse. Obstet Gynecol. 1996;88(3):470-8.
Dokuzlar O, Soysal P, Isik AT. Association between serum vitamin B12 level and frailty in older adults. North Clin Istanb. 2017;4(1):22-28.
The post Urinary Urgency and Incontinence: Why It’s Not Just Age appeared first on Mark’s Daily Apple.
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I’m 65, and though I’ve been able to stave off the worst of what normally passes for the “aging process”—as can almost anyone by paying attention to how you eat, sleep, train, move, and live—the fact remains that I’m not training like I used to.
It’s not so much that I’m “losing” a step, although it happens to the best of us. It’s that I’ve totally transcended the need or desire to train hard for the sake of training hard. There are no more competitions. My ego is content on the training front. I’m not wrapped up in pounds lifted or miles run.
I get regular questions about what I do for workouts and how they’ve changed over time. Today I thought I’d answer this.
Miami has a fantastic gym culture with impressive facilities to support it. I almost have to go the gym. It’s something I still enjoy. I just make it count.
I’ve managed to compress my time in the gym with “super-sets” for each exercise.
These aren’t always super-sets where you’re bouncing between the squat rack and the bench press every other set. The kind of super-set I’m talking about is a rest-pause super-set. I try to hit between 12-20 total reps—that’s my goal—in three mini-sets with minimal rest. The super-set is broken up into three subsets with very short rest periods.
An example: Deadlift, 9 reps. Rest 30 seconds. Deadlift, 6 reps. Rest 30 seconds. Deadlift, 4 reps. You’re done. That’s a total of 19 reps. Once I hit 20, I’m adding weight.
Why I like this method:
- Over fast. I get in, get a great workout, and get out.
- No meandering and wasting time between sets. There are hard rules (30-second rests) that I must follow.
- Hard to go heavy enough to hurt yourself. If you’re doing 15-20 reps with little rest, by necessity the weight you use needs to be manageable.
- But heavy and intense enough to produce benefits. I know, I know, feeling sore the next day isn’t a good barometer of how effective the workout was. That’s what they say, but everyone secretly loves and craves the feeling of DOMS. Really makes you feel like you did something worthwhile.
I’ve fallen in love with the trap bar.
At this point in the game, I don’t need to hit PRs on the straight bar deadlift. Trap bars just feel safer, more natural, more versatile. Some great possibilities (many of which I throw in) include:
- Trap Bar Deadlift With Squat Bias—Deadlifts with more knee flexion, almost a half squat.
- Trap Bar Romanian Deadlift—Knees soft but mostly straight, almost a straight leg deadlift with or without touching the floor in between reps.
- Trap Bar Power Shrug—Deadlift at a pretty good clip, explode upward and shrug the bar. Almost like you’re jumping without leaving the ground.
- Trap Bar Squat—Squat down, grasp bar, stand up, repeat. Stack some weights and stand on them for added range of motion/squat depth.
- Trap Bar Split Squat—Stand inside the hexagon, place foot on elevated surface (1.5 ft, about) behind you, perform a split squat, wake up sore.
- Trap Bar Row—Stand inside the hexagon, bend over at the waist, row that bar up toward your belly.
The average person can get 90-95% of the benefits using a trap bar instead of a straight bar. Maybe higher, even.
I lift for a different purpose now.
As for the weights I use, now that my PR days are behind me, I lift to avoid injury now more than anything. That means knowing what “heavy” really is and backing down a hair. I’ll do one or two upper body days, and one leg day each week. That’s it. Two, maximum three strength sessions.
I base my workouts around standup paddling and Ultimate Frisbee games.
Both of these are stressful enough (in a good way) that I want to be rested for (and from) those activities before I engage in a lifting session. Just to be clear, I play Ultimate all-out for up to two hours, so it’s become my sprint day.
The Miami Ultimate Frisbee scene is very high-level. I’ve fallen in with a regular pickup squad, and the level of competition rivals Malibu’s. So, that aspect of my activity hasn’t changed. I’m still getting my one day of Ultimate a week.
If I’m feeling up to it, Miami beaches are fantastic for sprints. You don’t go as fast because the sand is so powdery, but it makes you work even harder.
Miami has also really changed how I spend time with my favorite activity, standup paddling.
In Malibu, it was a bit wilder. I’d head out past the breakers and paddle in any direction. It was huge, free, open, and infinite.
In Miami, you have the ocean side which is great and much calmer than Malibu, but you also have these inland waterways, like huge canals running through Miami. I’ve been spending a ton of time exploring them, checking out the beautiful homes and boats and even the occasional manatee popping up. And because it’s so calm, I can really go hard without worrying about waves. While paddling is fun, I go pretty hard for at least an hour and up to 90 minutes, so it’s a serious aerobic day for me.
I walk more.
I can walk so much more in Miami. In Malibu, I had to drive somewhere to walk, whether it was a trail head for a hike, down to the beach for a stroll, or to Venice or Santa Monica to just wander. In Miami, Carrie and I can walk out the door and go the market, the water, the book store, the cafe, or just wander. It’s integrated into our day, not something we have to schedule. People don’t really think of Miami as a ‘walking city,” and it’s certainly no New York or San Francisco, but it beats the pants off Southern California.
Trap bar, rest-pause sets, and environment aside, what I train hasn’t changed all that much. I’m still lifting heavy things, running really fast, moving frequently at a slow pace, and doing activities I love. But somehow I’m doing a better job of seamlessly integrating them into my daily existence. I’ve minimized the amount of time I spend lifting without compromising my results. I’m using my compressed training to fuel the activities I love doing, giving me more time that’s also higher quality.
A lot of this could be the simple result of moving somewhere new after living in the same city for twenty years, sort of a honeymoon phase. We’ll see. My workouts here are even more a part of my general lifestyle. They’re, for the most part, parts of my life rather than interruptions to it, which is the ancestral model at its modern best maybe. That’s how I choose to see it.
Thanks for stopping by today, folks. I’d love to read your feedback and questions and hear what new routines you’re trying out. Take care.
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A commenter wrote a great comment that got me wondering:
As far as “the more exercise the better” study I wonder if folks who had to drop out of long distance cardio training due to injuries or cortisol driven exhaustion are considered in the equation? In other words, if you can tolerate chronic cardio you may live longer, otherwise it might break you down. Everyone has a sweet spot for exercising is my gut feeling and you have to “listen to your body”. I still like the primal mantra along the lines of (if I may be so presumptuous as to paraphrase Mark) “walk a lot, do sprints once a week, lift heavy things once or twice a week, spend time outdoors, take part in sports or recreational activities that are fun for you”.
What do I think is going on? How do the results of this paper jibe with my take on Chronic Cardio?
First off, we have to acknowledge the basic structure of the study.
This study didn’t actually measure “hours spent training.” They gave subjects treadmill tests (stress tests) to determine their cardiovascular fitness, then divided everyone into different tiers of fitness based on the results. In fact, the authors of the study criticized the shortcomings of previous studies which used self-reported training data instead of objective measurements of cardiorespiratory fitness like the treadmill test. This makes the study far more accurate and useful. It also means you can’t make any ironclad proclamations about the connections between hours spent training and longevity. You can certainly make inferences—people who had better cardio fitness probably spent more time training to get it—but there are other interpretations. All you can say for certain is that higher levels of cardio fitness predict greater longevity.
I don’t see how anyone could argue with that. Of course being fitter is better.
But my criticism of chronic cardio isn’t a criticism of cardiovascular fitness. It’s a criticism of how most people go around obtaining that fitness—by destroying their bodies.
That doesn’t have to happen anymore. Tons of top guys these days are finally figuring out that you don’t have to log as many laps/miles/etc as possible to maximize your performance, but that wasn’t always the case. I grew up convinced that the more miles I ran, the healthier I’d be. That’s how I did it back in my marathon and triathlon days, and it almost destroyed me and an entire generation of my peers.
You can train twice as much as the next guy yet have worse fitness, either because you’re not training intelligently, you’re overtraining and hampering the adaptive process, or you’re not sleeping. That’s chronic cardio. You can train less and get better results, if you’re optimizing your recovery, nutrition, and sleep. That’s Primal Endurance.
As for these subjects, there is some serious genetic confounding occurring. Those dudes with elite fitness levels well into their 70s are often a different breed. They’re hard to kill. They’re tough. They can withstand the discomfort of grueling mile after mile. What other types of discomfort can they bear and even grow from? They’re just more robust than the average 70-year-old. It may not be the elite training itself that’s making them resist death. It’s just as likely they have the genetic capacity to excel in endurance training, and even if they didn’t exercise they’d still live longer than average.
There’s also the healthy user bias. The kind of lifestyle regular exercisers follow emphasizes sleep, plenty of rest and recuperation, smart supplementation and nutrition, and all sorts of other things that are also linked to longer, better health.
This paper makes a strong case for using something like Primal Endurance to build great cardiorespiratory fitness without risking chronic cardio territory.
Thanks for writing and reading, folks. Take care!
The post Dear Mark: Is There No Upper Limit to Endurance Training? appeared first on Mark’s Daily Apple.
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As many of you know, Brad is my longtime writing partner, host of the Primal Endurance podcast and host of the weekly keto show on the Primal Blueprint podcast. Our relationship goes back 30 years to when I was Brad’s coach during his career on the professional triathlon circuit. The start of Brad’s chronic plantar fasciitis ordeal dates back nearly that long, until he was completely cured in a matter of weeks back in 2011. Hence, the subject of today’s post! If you are a sufferer, pay close attention because we dove deep into this topic and are giving you the tools to never suffer again.
Indeed, as Brad will detail shortly, miracle cures are possible, even for extreme sufferers. About three years ago, Brad was over at my place on a Monday and noticed me spending a lot of time rubbing and stretching my chronically tight Achilles tendon; it had taken its weekly beating the previous day at Ultimate Frisbee. I tried the prolonged stretches he details in the article and experienced immediate relief. (Around the same time, I also started to experiment with the early supplemental collagen products on the market, which also helped my foot issues and other joint aches and pains clear up.).
Enjoy today’s article, and let us know your thoughts on this treatment protocol.
Plantar fasciitis—it’s painful to even pronounce, and if you contract this condition you’re in for a long, frustrating, painful ordeal. It’s characterized by a burning sensation around the rim and/or bottom of your heel, and assorted peripheral pains such as a sore or burning arch, sensitive nerve endings along your arch, inflamed bursa sacs in your heel bone that make the heel sensitive to touch and applied weight, a bumpy, lumpy sensation on the bottom of your heel that are often called bone spurs, and general stiffness, tightness, and pain in the foot, arch, Achilles tendon, and calf muscles.
Symptoms are typically worse first thing in the morning or after prolonged periods of sitting or standing. If you have a mild case, you can get some range of motion and blood flow going upon awakening and the pain will typically subside and not compromise your exercise. In advanced stages, you will have a hard time getting mobility going and even walking will be painful. When you do get sufficiently warmed up and into a workout, the burning pain will often continue during and after exercise. The condition can worsen over time until you are sidelined by the lack of mobility and subsequent chronic pain.
Explaining Plantar Fasciitis: Anatomy and Causes Behind It
The plantar fascia is a super-strong ligament that runs the length of the bottom of your foot. On one end, the plantar fascia attaches to the metatarsal bones of each of your toes. It then fans out wide, like a sheet covering the length of the bottom of your foot. It subsequently tapers to attach into your calcaneus (heel bone). The plantar fascia acts as a prominent shock absorber when you walk, run, or jump. Consequently, it gets put under a lot of stress and can easily become inflamed when the muscles, ligaments, and tendons in your lower extremities are dysfunctional or overstressed.
Plantar fasciitis is extremely common among not only runners and competitive athletes but also folks who work on their feet all day like nurses, laborers and even standup desk user. Then there are people who have strong sedentary patterns (commute, desk job, insufficient exercise); people with arthritis, obesity, poor muscle tone, flexibility, mobility or generally poor physical fitness; and people who wear crappy modern shoes with stiff construction, encased toe compartments, and elevated heels. Does that pretty much cover the entire population of the developed world?
Indeed, no one is immune to the risk of plantar fasciitis, because the condition often comes about when there is any sort of weakness, overuse, inflammation, or dysfunction in the muscles, tendons, and ligaments in the lower extremities. For example, if your calf muscles or Achilles tendons become stiff and inflamed from doing chronic cardio or consuming an inflammation-boosting high-carb, allergenic-loaded, SAD diet, these dysfunctions may manifest most painfully as plantar fasciitis.
I don’t know many serious runners who haven’t had this condition at one point or another in their lives. I had the condition for the better part of 15 years—ranging from a mild lingering annoyance that vanished with some quick morning exercises that increased blood flow and mobility, to so debilitating that I couldn’t walk in the morning. Indeed, for several years in the midst of my professional triathlon career, I had to exit bed onto one leg, hop out the door into the backyard, then drop my right leg into my backyard spa. Only after a few minutes of working through ankle and calf range of motion with hot jets blasting could I apply pressure to the foot and walk normally. Then, I’d lace up my shoes and head out for a run of five, ten, or even twenty miles!
That’s a strange juxtaposition from cripple to endurance machine in a few minutes, but it generates an important reflection: plantar fasciitis almost never gets better with rest alone. On the contrary, it quite often gets worse when an injured athlete stops running or a nurse takes a leave from the ER floor for a desk position. For example, during one off season of my professional career, I decided (in consultation with my coach Mark Sisson) to take a six-week break from running in order to focus on swimming and cycling and allow the painful plantar fasciitis injury to heal once and for all. Upon my return to light jogging, you can guess what happened: the injury was more painful than ever!
Interventions That Address the Symptoms, Not the Cause
Before we get to the prescribed treatment protocol, let’s look at what interventions are commonly suggested but generally don’t work well at actually treating the condition. (See how many look familiar.) As you might expect, athletes and active folks have tried all sorts of treatment modalities and remedies, most of them landing somewhere on the spectrum from ineffective but harmless to outright disastrous.
Well intentioned as it may be, rest is usually ineffective with plantar fasciitis. Getting off your feet or out of your exercise groove results in atrophy of both the large muscles and small stabilizer muscles in your legs as well as reduced range of motion, increased stiffness, shortened muscle, and—often—more pain when you try to return to your normal activities.
Orthotics, Arch Supports, Arch Taping
These approaches work like a Band-Aid works to stop the bleeding. If you have plantar fasciitis and have to perform for your country in the Olympics, a professional taping job is a great idea to keep the pain at bay and allow you to qualify out of your heat for the quarter-final. Alas, these support measures fail to address the cause, however.
Furthermore, they can very often compromise healing if you insist on using them long-term instead of making a sincere commitment to addressing and healing the underlying causes. Specifically, using artificial aids and supports will cause weakening and atrophy of the lower extremities over time. You make things easy for your feet, so they can wither away inside a cushy protective cocoon instead of be challenged to grow stronger every moment that you ambulate.
That said, remember that staying active is essential to ultimate healing of plantar fasciitis, and so using support measures to help you stay active by any means necessary can be warranted over the short term.
Ice, Heat, Electrical Stimulation, Ultrasound
These and other feel-good techniques are generally focused on relieving painful symptoms—symptoms that are bound to return again and again over time until you address the cause. As previously stated, complementary therapies are fine to the extent that they help keep you active. Ice massage can also be helpful in the aftermath of performing some aggressive healing exercises, as we will discuss shortly.
This can be highly effective to undo some of the damage caused by chronic injury and facilitate healing. In particular, Active Release Technique (ART) and deep tissue techniques go a long way toward increasing the mobility and fluidity of muscles and connective tissue.
The caveat here is that deep massage and ART treatments set you up for success, but you have to do the healing work described shortly to make the effects stick. Otherwise, you will undo damage with the bodywork, then create the damage all over again by exercising on dysfunctional legs.
Can you say “rupture”? Not rapture, but rupture. Yes, ouch! Generally, cortisone injections provide immediate and amazing relief from pain symptoms, often at extreme risk to your long-term health. When you override your body’s natural inflammatory processes and pain signaling with a powerful drug, you gain instant relief, but increase injury risk because you no longer are governed by natural tightness and pain that is attempting to protect you from the damage of performing with a dysfunctional appendage. Furthermore, anti-inflammatory treatments (including chronic use of seemingly innocent NSAIDS before workouts) weaken your natural ability to regulate inflammation over time.
There are a tiny fraction of injury cases where a cortisone injection may provide enough relief to facilitate an aggressive rehabilitation process that results in healing, but I urge extreme caution here. I say “extreme” because you may face enthusiastic health care professionals who will pretty much beg you to accept an injection. I know someone whose decades long nursing career ended in large part due to a cortisone injection that preceded a rupture, multiple surgeries, and ultimately a downward spiral that ended in permanent disability status.
The Plantar Fasciitis Cure: An Extended Stretching Regimen For Fast Healing
When you address the causes of plantar fasciitis, you’ll experience relief from the painful symptoms surprisingly quickly. To correct the cause, you must lengthen your calf muscles, increase mobility throughout the lower extremities, and start a methodical progression to a more minimalist/barefoot lifestyle. Commit to the following protocol every single day for just a couple weeks and it’s quite likely that even a severe and debilitating long-term condition will clear up to the extent that you will be pain-free and fully functional in a matter of weeks.
Lengthen Your Calf Muscles
“Do the wall stretches several times a day. Hold each stretch for two minutes. You’ll be healed in a few weeks.” This brief quip was all I needed to cure 15 years of consistent pain and suffering from plantar fasciitis. The message was delivered to me in 2011 by a podiatrist in a booth at the race expo of the Sacramento, CA, Urban Cow Half-Marathon and 5k—where I am the announcer annually. I have tried in vain to figure out who the guy was, but I’ll extend my deepest gratitude to the mystery healer right here and now.
Here is what happened on that fateful day: I typically walk the grounds and meet the exhibitors, so I can give them a little plug over the P.A. I remember from that day a booth with signs about healing foot pain and exam tables set up for interested runners. An enthusiastic podiatrist greeted me at the booth and started talking about how he could easily and quickly cure conditions like plantar fasciitis.
I challenged his assertion, informing him that I’d had the condition for 15 years and had tried everything: morning Jacuzzi hopping, a heel lift in my right foot, removing the heel lift, returning the heel lift, expensive rigid orthotics custom molded from my footprint, expensive soft “dynamic” orthotics made of silicone gel, obsessive icing and stretching, wearing giant pillow cushion shoes from Nike, switching over to Vibram Five Fingers and other minimalist options, switching back to pillow shoes—basically everything short of the dreaded cortisone injection.
I eventually agreed to try the prolonged stretches, obviously with huge reservations but a sincere commitment. In a few weeks, my symptoms were completely gone for the first time in 15 years. I’d call it a miracle, but it was so incredibly simple I’m not sure you can call it a miracle.
Extended Wall Stretch
Hopefully, you’re familiar with the wall stretch that is the runner’s bread and butter? You extend one leg behind you, lean into the wall at a 45-degree angle, and push against it like you are trying to push it over. With your rear leg straightened and heel grounded, the stretch focuses on the soleus, the narrow muscle running along either side of your leg and merging at the bottom into your Achilles tendon. When you bend your rear leg and lift your heel off the ground, you redirect the emphasis to the gastrocnemius, the ball-shaped muscle that gives you that sexy rock-hard definition on the upper part of your leg.
Holding each of the aforementioned four stretches (left leg straight, left leg bent, right leg straight, right leg bent) for two minutes is the secret to healing. In case you’ve never timed your stretches, holding a single position for two minutes will likely seem like an eternity. I’d speculate that the most devoted stretching enthusiasts might never hold a single stretch for than 10-20 seconds. Even the most deliberate of yoga classes won’t hold you in a single position for that long. As I mentioned, I had devotedly stretched my lower legs and feet in assorted ways for years in the tug-of-war against my condition, but never held any single stretch for so long.
Why Two Minutes?
When you hold a stretch for two minutes, you are sending a powerful message to your musculoskeletal and central nervous systems to lengthen the relevant muscle fibers. Witness ballerina dancers stretching for hours every day in order to maintain optimal muscle function for their demanding efforts—constantly reinforcing the message to brain and tissue that they need to by hyper-flexible.
This process of lengthening a muscle is complex but important to understand. If you listen to or read the Nutritious Movement commentary from noted biomechanist and author Katy Bowman, you may be familiar with the term proprioceptors. These are the nerve endings that help your muscles communicate with your central nervous system. When your proprioceptors detect a muscle fiber being stretched, something called the stretch reflex is triggered. This reflex causes a stretched muscle to contract—an excellent safeguard against injury during assorted day-to-day activities, including fitness activities and sports.
After a workout in which muscles have repeatedly contracted or absorbed impact, holding a few stretches for twenty seconds will send a nice little message to the fibers to relax and loosen up a bit as you transition from a state of exertion to relaxation. Then the stretch reflex kicks in, you experience a little discomfort, and end the stretch. When you go big time, work through the possibly uncomfortable stretch reflex sensation, and hold the muscle in a stretched position, you start to make some real progress. Here the proprioceptors in the stretched muscle, known as the muscle spindles, become habituated to the new length of the muscle such that the stretch reflex is muted. Instead, when specific thresholds of stretching frequency, intensity and duration are exceeded, a lengthening reaction occurs in the muscle. Here the muscles relax and allow you to deepen into the stretch. If you have ever been to a yoga class and noticed you can take stretches much deeper after you are warmed up and habituated with repeated stretches, you may know what this lengthening reaction feels like.
When your muscles relax due to the lengthening reaction, another key player on your healing team jumps into action: the golgi tendon organ. This is located in the tendon near the end of a muscle. It sends a message to your central nervous system, essentially: “Hey, this dude is sick of suffering with plantar fasciitis for 17 years. He wants some longer calf muscles for Christmas, so please comply.” Enjoy this much more detailed and scientific discussion of the science of muscle stretching.
Tips For Adopting the Healing Protocol
If you want to heal quickly, strive to quickly work up to doing the wall stretch protocol several times a day (shoot for five times or more). As described previously, this will take all of eight minutes per session: two stretches on two legs for two minutes each. An aggressive stretching regimen will, in a matter of days, greatly relieve the stress on your arch and heel caused in large part by shortened muscles that don’t absorb impact optimally.
Because of the high degree of difficulty with two-minute stretches, you can expect some next day soreness. Take care to stretch only the point of mild discomfort instead of actual pain. This may mean you have to back off a bit during your wall push to survive until the two-minute bell. You will also likely discover that you will be able to hold a much deeper stretch in the evening than in the morning, and more easily reach the two-minute bell. Alas, doing these stretches first thing in the morning when your muscles are the shortest is critical to your progress. So is doing them as many times per day as you are willing. Remember, we are trying to work beyond the stretch reflex and achieve a lengthening reaction.
You may even consider getting the legendary Strassburg sock to assist your healing process. This device, a sock with a strap attached, places your ankle in a flexed position all night, putting the plantar fascia under tension so that it does not contract and cause the painful morning stiffness. Instead, you wake up with an elongated plantar fascia much like the afternoon version that feels much better to walk on than the morning version. Again, the sock is best used in conjunction with an aggressive healing protocol.
Please keep in mind this prolonged stretching protocol is designed for injury prevention/healing, and is not advisable right before a workout. You may have heard prominent accounts of how static stretching can temporarily weaken a muscle for up to 30 minutes, and this is a valid concept. After all, you are about to demand intense contractions from your muscles for the workout, so aggressive pre-workout stretching is not the best way to prime them for action. Instead, do a simple warmup—increasing body temperature and respiration to the extent that you break a little sweat.
Watch this video where I describe the power of the wall stretch to heal plantar fasciitis and direct you to do the stretches correctly.
Mobilizing Lower Extremities
Concurrent with your commitment to prolonged calf stretches is a commitment to achieve increased mobility and flexibility in the foot and leg, via a series of special movements and treatment modalities with colorful nicknames. If you’re in the Crossfit scene or otherwise a fan of Dr. Kelly Starrett, aka “K-Starr,” you might be familiar with some of the unique and colorful terminology—terms like bashing, tacking and mobilizing—that have become his custom lexicon and spread like wildfire into the fitness community. K-Starr is a former elite level whitewater kayak athlete, proprietor of San Francisco CrossFit, creator of the popular MobilityWOD.com website, and author of Becoming a Supple Leopard—perhaps the most comprehensive volume on mobility, flexibility, functionality, healing and prevention for athletic folks ever in the history of the world. Visit MobilityWOD.com to get a free 10-day dose of Kelly and his highly engaging, informal, and humorous style with which he conveys his unique and effective approach.
K-Starr is a big fan of using toys like massage balls, golf balls, lacrosse balls, foam rollers, voodoo straps (try this Voodoo Floss treatment for plantar fasciitis) and even elbows in an aggressive and focused manner to increase blood flow, improve range of motion, and facilitate healing in muscles and connective tissue. Once your mobility improves, you then have a fighting chance at exhibiting correct functional movement during exercise and daily life (e.g., running with a balanced center of gravity over your feet and an efficient dorsiflexion of the foot on each stride), such that you won’t be doomed to a lifetime of repeating injuries, both acute and overuse.
Regarding plantar fasciitis, Starrett recommends attacking the cause by working to increase mobility, flexibility, and functionality throughout the lower extremities. You can check out his full suggested regimen on YouTube.
Complete the prolonged stretching plus mobility work protocol several times a day until the pain and stiffness are nearly when you awaken in the morning. Then you can shift into maintenance mode where you might do the stretches once or twice a day instead of five to seven times a day. And you might do your bashing, tacking and mobilizing only in the aftermath of tough workouts when you experience next-day stiffness.
Your main objective is to prevent the shortening and lost mobility that laid the foundation for plantar fasciitis in the first place.
Look for Brad’s follow-up post on preventing plantar fasciitis from setting in (or re-occurring) later in just a couple weeks. In the meantime, give your focus to the treatment, and let these stretches do their magic. Thanks again to my friend, Brad Kearns, for stopping in and sharing his experience today.
Again, you can follow Brad on his new podcast, Get Over Yourself, where he gets to unleash his lively personality and cover broader topics including health, fitness, peak performance, personal growth, relationships, happiness, and longevity, always with humor and a little spice.
Thanks, everybody. Be sure to share your thoughts and questions on plantar fasciitis below. Have a great end to your week.
Phil Maffetone and Dr. Frykman, barefoot running podcast
Dr. Kelly Starrett Plantar Fasciitis
Plantar Fasciitis, Fix Your Feet
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