Archive for the ‘Aquatic Therapy and Training’ Category

There’s Nothing “Humerus” about Fracturing your Funny Bone!

July 30, 2014

Five weeks ago my life changed in an instant when,  while running fast downhill on an uneven rocky trail, I tripped on a rock and tumbled down hard, landing directly on my left elbow on a rock. The impact felt like someone had struck a hammer against the back of my elbow and I sensed something snapped off in the impact. Sure enough, a few hours later x-rays revealed that I had fractured my olecranon – the infamous “funny bone”. Fortunately it was a “clean, simple” break rather than a compound one, but nevertheless the solution for healing the injury turned out to be anything but simple.

It turns out that most olecranon fractures require surgery because they typically displace (the fragments separate too much for the bone to rejoin on its own). The fragments of the bone must then be reduced or returned to their normal position until healing occurs – usually in six weeks. Surgery involves reducing the bone fragments with some type of hardwire – usually a plate and screws. If there are multiple fractures or the bone is shattered, wires and pins may be used. In my case the bone fragments were reduced a little less than an inch so a plate with one long screw was inserted into my elbow and running down my forearm (part of my ulna bone). Like most patients, my arm was immobilized for a few days with a heavy splint and ace bandages wrapped around the dressing of my surgical wound (which I kid you not was four inches long and held together with about 16 staples). Three days later a plastic, removable splint was molded to my arm and I was encouraged to wear it day and night for the next five weeks, with the exception of removing it 4-5 times daily to perform extension movements (bending and straightening of the arm)  to encourage range of motion.

The recovery from surgery, however,  proved much more painful than the original fracture. In particular the first two days after surgery I was in a lot of pain (not helped by the fact that I refused to take a narcotic – in this case Vicodin- choosing to stick instead with Advil. My entire left arm and especially my left hand was very swollen and black and blue. I was instructed to elevate it as much as possible which was only really possible at night, but which made sleeping virtually impossible. Fortunately, my clever husband rigged up a pulley system from our bedroom ceiling which was attached to my arm and allowed me to elevate comfortable and shift positions as well.

To be honest, until this happened, I never gave my elbows much thought. I took for granted that they worked well and that my relatively strong triceps allowed my elbows to extend and to some degree even hyperextend.  That has all changed now that four weeks after surgery my stiff left arm is still far from straightening. I am, however, finding some improvement every day. Today when I washed my hair I was able to wring it out using both arms and I can now floss my back molars without too much discomfort. Just yesterday I was able to scratch my right shoulder and tonight I even made a salad and was able to toss it myself. Ahhh, the little victories are sweet as I slowly get my life and independence back. I really miss my yoga classes and it’s been five weeks since I’ve been able to swim laps, but I’m back in the pool with my clients which I know is really helping my healing process.

UPDATE I:  I had a great PT session yesterday and I was told I’m a week ahead in terms of healing and range of motion (ROM). She said I can go without my splint except in situations where I can’t control my environment, such as in a crowd. I will see my surgeon next week for a follow-up and hopefully he will tell me I can begin a strengthening program. Last night I slept without my splint and I’m just about to go for a run without it – can’t wait!

UPDATE II:  It’s now been 10 weeks since the injury, 9 weeks since surgery. Saw my surgeon this week for my final post-op. He was thrilled with my ROM and strength and lifted all restrictions. The only glitch was that 10 days ago I developed a grape-size “seroma” (a collection of subcutaneous fluid) on my forearm at the end of the incision where part of the plate is. He assured me it was harmless – just the body’s reaction to irritation at the plate, but he decided to aspirate it anyways and withdrew 3.5 ml (about a thimble-size) of light red fluid – mixture of blood and plasma. He said if it comes back we may want to consider surgery to remove the plate and that he didn’t recommend that until at least 3-4 months after surgery. I just figured I would be living with this thing the rest of my life and would really rather not go through another surgery to have it removed, but he did assure me that the recovery time for plate removal surgery is much less than the insertion was. Hopefully that’s the end of it, but stay tuned….My PT also gave me my walking papers this week, so while the healing process continues she says I can do the rest on my own :)….My downward dog is slowly coming back and now I’m able to swim without even being aware of my left arm – even as I turn to breathe to the right side (where I have to fully extend my left arm) – which was painful for awhile. Now, if I could only have Summer back…..

UPDATE III:  It’s been almost 13 weeks since the injury, 12 weeks since surgery and yesterday I finally had the courage to run to the place I fell. Previously every time I thought about doing so I became both nauseas and nervous. Yesterday I was still a bit nervous – not that I thought I would fall again), but I felt ready to face it. Interestingly I discovered the way I fell wasn’t what I thought. rather than fall downhill, I actually fell on an uphill slope. I realized and remembered that I slid on loose rock, my feet coming out from under me, and I landed to the left the way the hill sloped on a rock. I saw so many large rocks sticking out of the ground yesterday that I’m not sure which was THE ROCK, but it’s clear that it could’ve been any number of them.  I felt a real sense of relief afterwards and strangely fatigued as well as though I was able to put down a burden I’ve been carrying for the past few months. When I do run on that trail again I will be extra cautious as I can see now how rocky it is and how easy it was to fall in various places. Overall my elbow is doing well. I’m working on getting the final degrees of extension (straightening the arm) and my strength is almost there in most ways. For example, I can now pull the hatchback trunk of my car down completely with my left arm with no pain and with relative ease.

UPDATE IV: It’s now been 15 weeks since my olecranon reduction surgery and my elbow is doing great. I’m even back to doing power yoga and though my left side plank is still a little shaky, I can even do wheel pose and “flip my dog”! But….I went to see my surgeon last week because my forearm, (not where the injury was, but where the metal plate and screws are)  still gets very irritated when I place it on a table, or even on my leg when doing side angle pose in yoga. I wanted to ask the doctor about having the hardware in my arm removed. He said that because I don’t have much padding there I will always be irritated by the hardware and that I’m a good candidate for removal surgery. So I’ve scheduled to have my plate and screws removed 3 days before Christmas. The recovery is supposed to be much faster and easier than the surgery to have the hardware inserted, plus I won’t have a broken bone and torn muscles to mend this time. However, I will have to avoid any heavy lifting for about 5 weeks. I’m excited to have my arm eventually return to it’s previous pre-injury, metal-free state. When the hardware is removed I will initially have holes in my ulnar bone where the screws were, but with time the bone will fill in. All for now….stay tuned.

UPDATE V:  12/23/14…Yesterday I had surgery to remove the titanium plate and six screws in my left arm. It was definitely a case of deja vu in returning to the surgery center – almost exactly 6 months to the day from the first surgery to have the hardware installed. I’m very happy to report that so far my pain is far less than the original surgery and very manageable. In fact in 24 hours I’ve only taken one 200mg Advil when I got home yesterday (and I probably could’ve done without it but they keep telling you in recovery to “stay ahead of the pain”). I’ve not needed to take anything else – even last night when I thought the pain might kick up in my sleep. The other main difference is that, unlike last time, my arm and hand are not at all swollen or discolored despite the fact that I haven’t been elevating them as much as I probably should be. I have a huge, bulky temporary cast from my shoulder to my wrist that doesn’t allow me to straighten my arm, but fortunately I only have to wear it for 2 days after which I will transition to a sling for a week or so. The only complication with my surgery was that the bone had started to grow around the plate at the elbow requiring the surgeon to dig into the bone to remove it. Hopefully that won’t delay my healing. This is another reason I’m glad I didn’t wait any longer to have the hardware removed as apparently the longer it’s left in, the more likely bone can grown around it, making it more challenging to remove. All in all, I’m very relieved to have had the hardware removed. I asked for it as a souvenir and it’s a bit eery to see what I’ve had inside my arm for almost six months, but his was my Christmas gift to myself and I’m very glad I did it.

UPDATE VI 12/24/14…Saw my surgeon today for my 48-hr post op appointment and it felt like an early Christmas gift. He removed the bulky temporary cast and was very pleased with what was underneath – so much so that he said I didn’t need to wear a sling. Additionally, he said I can get back in the pool next Monday, a week earlier than he’d previously said I could. I’m now wearing a light dressing over the incision and a “sleeve” to protect it. My pain remains very manageable and I haven’t had to take anything for it. My elbow is a bit swollen and stiff and tender to the touch (feels like I’ve scraped and bruised my arm), but really not that bad. I have to be careful for the next 4-5 weeks (no pushups or significant twisting motions), but once I get the sutures out I don’t have to go back to the Dr. unless there’s a problem.  Hallelujah!


UPDATE VII 12/8/17 I’ve been hearing from some of you about your experiences with olecranon fractures, ORIF surgeries and even hardware removal surgeries. My heart goes out to you as I know how devastating and painful this injury and the surgery can be. I’m happy to report that I rarely think about the injury today. I healed easily from the hardware removal surgery, regained full ROM and strength and was quickly back to all of my physical activities as soon as my surgeon gave me the green light.

I’m glad to know that sharing my experience has helped you, but please know that everyone’s journey is different. We are all individuals with different circumstances. The best way to predict your outcome is to speak with your doctor and your PT. I wish you all the best in your healing process.

Be Well and Happy Holidays,



A Personal Journey of Healing

December 28, 2011


For me, 2011 has been a journey of healing. As I’ve mentioned in previous posts this year, I’ve been suffering from Haglund’s deformity – a chronic form of calcaneal bursitis (inflammation of the bursa sac that cushions the back of the heel) that results in hypertrophy of the heel bone. I’ve also been dealing with Achilles tendonitis which is commonly associated with this condition.

What was strange in my case is that, although this is a chronic condition, mine seemed to come on suddenly despite the fact that I didn’t change my footwear or my activities. In fact I run far less than I used to so it’s ironic that this problem cropped up at this time in my life. After suffering for many months while trying all of the standard allopathic medical treatments for Haglunds with no improvement, I decided to have surgery. I even scheduled the procedure, which involves shaving the heel bone, the permanent removal of the bursa sac and the temporary detachment and re-attachment of the Achilles tendon. The post-surgical recovery process is long and arduous and there’s no guarantee of a successful outcome or that the problem won’t return.

As the date of my surgery loomed I began to have second thoughts  – particularly the prospect of a 6-month layoff from physical activity. Instead I decided to try the laser therapy  and LED light therapy treatments offered at my chiropractor’s office, figuring I could always have the surgery later if they weren’t successful. Much to my delight I experienced improvement and was encouraged by my gradual progress – namely my ability to do more with less pain. During the summer I added bi-weekly acupuncture treatments and noticed a further reduction in my symptoms though the bursa and heel bone never shrunk in size. I began competing in 10ks and I even ran (and was the second female finisher) in a half-marathon. I also added a lot of cycling to my workout regime which helped strengthen my foot without pounding the pavement. As usual, deep water exercise was a staple and savior in my life and also helped strengthen my foot and keep me in shape without adversely affecting my heel or Achilles. As long as I didn’t run too much or too many days in a row I was able to continue. I was even able to return to running hilly courses and even competed in hilly races.

But by late Fall I became discouraged as my pain began to return and my progress seemed to plateau. Still adament about avoiding surgery, I began receiving homeopathic injections of Traumeel directly into the bursa. (This procedure is commonly performed in Europe though not in the US). I have had 5 rounds of Traumeel injections and plan to have one more next week. They are extremely painful and cause the bursa and overall pain and stiffness in my foot to increase for about 48 hours. The jury is still out as to whether they are effective, but I do feel that my foot is slowly changing for the better. I’ve also been taking Traumeel homeopathic tablets (instead of non-steriodal anti-inflammatories which with chronic use can delay healing) and have continued using Traumeel ointment on my heel – particularly the 2 days following the injections.

I also changed to a softer and smaller heel lift – after wearing a hard rubber one for years in my right shoe because of a leg difference resulting from scoliosis. Perhaps most importantly, I’ve been working on altering my running gait, attempting to adopt more of a barefoot style of running (but with shoes on!) instead of that of a heel striker (as I’ve been all my life). Old habits do die hard as this has proved extremely challenging for me! I’ve also discovered the joy of tandem bicycling – it’s great exercise and also doubles as couples therapy :). More on that in a future post.

I’m still hoping to avoid the knife, though I realize that there’s no other way of returning the heel bone to its original shape so I may resort to that at some point. In the meantime, other than running shoes and cycling shoes I mostly wear clogs, mules, backless sandals and flip flops to reduce the pressure on the back of the heel.

I’ve learned a lot this year in this journey of healing….most of all not to give up hope. The body has an amazing capacity to heal itself if given the right tools.

Be Well and Happy New Year,


UPDATE I:  Well I went back to the Dr. today expecting to have my final Traumeel  injection, however because my results have been rather underwhelming he decided to take the next step and try prolotherapy on my heel bursitis and Achilles tendonits. Prolotherapy involves the injection of a dextrose (sugar) solution (also includes Vitamin B-12 and Vitamin A) into the ligament or tendon where it attaches to the bone or any painful area. This results in a localized inflammation in these weak areas which supposedly increases the blood supply and flow of nutrients and stimulates the tissue to repair itself. If I thought Traumeel injections were painful, this was easily twice as bad probably due to the larger needle and the deeper penetration into the bone and surrounding tendons and ligaments. I had trouble walking within 90 minutes of the procedure when the pro-caine (anesthetic)  wore off.  Tonight I’m  limping around and strangely enough it feels as though I sprained my ankle. I was told the pain and swelling would increase for approximately three days, but this is worse than I expected.

Here is a link to a video (see #11 on the sidebar of videos) of a patient receiving the injections in his foot  (my injections were in the back of my heel and Achilles tendon). Don’t be fooled by the Dr.’s assertion that the injections are easily received by the patient. That was not my experience and I have a high pain threshold!

UPDATE II: I never returned to have additional prolotherapy or traumeel injections. It took me 5 weeks to return to my previous activity level prior to the injections and I experienced no improvement in my symptoms. Bottom line:  this approach didn’t work for me. Currently I’m continuing my home remedies and varying my activities (alternating running, cycling, exercising on the elliptical trainer, swimming and water exercise) and being very mindful of my choice of shoes – backless whenever possible.

UPDATE III:  Well it’s mid-May, 2012 and I’m happy to report that I’ve had a relatively active, pain-reduced three weeks. On the advice of my old chiropractor (whom I saw during a recent visit to Tucson) I’ve been taking a homeopathic medicine called “Osteoheel“. I do think it is helping to reduce my pain and possibly even size of the bump on the back of my heel. It’s definitely decreased the burning sensation in my heel and achilles tendon. About a week ago I started using a homeopathic ointment called “Topricin Foot Therapy Cream“. I believe it’s also working to temporarily reduce my pain and stiffness. I’ve used Traumeel religiously for years, but I’ve not found it to be effective on this foot condition – perhaps Topricin will fit that bill. I’ve also changed to a running shoe that has a smaller difference in height between the back heel and front part of the sole (only a 4mm difference as opposed to the typical 8mm difference). It also has a more flexible sole. It took some getting used to, but I’m having less pain both during and after running. I’ve even been able to run back-to-back days and a couple of days I go I did a 9-miler. I’m still doing a lot of tandem cycling and spinning where I have little or no pain and I’m in the pool almost every day – whether for work or a workout. I continue using my golf ball on the bottom of my foot to keep the plantar fascia tissue pliable. I just keep it under my dining room table where I can use it while I’m eating or working at the computer.

I’m not sure if this is just a positive phase I’m experiencing or whether my condition is actually improving. Only time will tell… stay tuned….

UPDATE IV (October, 2012):   After a frustrating summer of plantar faciitis in my  good foot, I’ve experienced a really good 6 weeks. Other than a bit of stiffness in the morning and occasionally some minor Haglund’s pain, both feet have been feeling really good. Even after running almost every day in France on vacation and walking miles all over Paris, my feet felt pretty darn good. I’ve continued taking the Osteoheel but only when I need it rather than taking it preventatively. The only thing I’ve done differently is completely eliminate artificial sweeteners. A year ago I stopped chewing sugarless gum, the only source of artificial sweetener I was consuming, suspecting at that time that it might be contributing to my Haglund’s pain and leg and foot cramping. My condition did improve when I switched to what I thought was sugar-based gum when I chewed it occasionally. Eight weeks ago I happened to read the label more carefully on my Wrigley’s doublemint gum packet only to discover that  it now includes artificial sweeteners (aspartame mostly) in addition to sugar – albeit a smaller amount than in “sugar-free gum”. I immediately stopped chewing it and within a week my foot pain decreased dramatically. Coincidence?  Possibly…but for now, I’m avoiding all artificial sweeteners and reading labels carefully. I suspect I’m sensitive to any amount of them – no matter how small. On a related note, I noticed in France that almost all chewing gum and mints for sale were artificially-sweetened – similar to the US. I doubt that was the case even 5 years ago, but it appears to be a growing trend both here and abroad. Artificial sweeteners are being linked to so many health problems that it surprises me that the market for their products is still booming, especially in Europe where, for example, homeopathy is an accepted, even mainstream practice and genetically modified foods are banned.

UPDATE V (December 31, 2012)  Over the past few months I’ve gradually been able to increase my running mileage. I was thrilled to be able to do a few 90 minute runs with no negative consequences other than some post-run stiffness soreness in my soleus and Achilles – all of which went away quickly. But TODAY I ACTUALLY RAN 2 HOURS AND 5 MINUTES!!! I haven’t come close to that in 3 years. I am a bit sore tonight, but thrilled nevertheless. I feel really good about starting 2013 feeling more like my old self physically. The only other thing of note that has happened was a 2-week period a few weeks ago where I experienced sudden, sharp knife like pains in my right foot – both the medial and lateral parts of my foot – especially at the heel and Achilles. My ankle would also suddenly lock up on me. Strangely enough the pains would decrease or even subside after urination. I’ve since discovered that this is probably tiny fragments of the hypertrophied bone breaking off. Apparently this is common in the case of bone spurs. These “loose bodies” can find their way to your joint or soft tissue. Fortunately it went away, but it really helped just knowing what was causing it – especially as it was quite painful. Interestingly, my fiance started measuring the “circumference” of my Haglund’s heel with a tape measure a couple of months ago. It had been 26.5 cm before this painful episode. On Christmas Day he measured it again. It had been about a month since the last time he measured it and this time it was 26.0 cm!!! Could it be my hypertrophied heel bone is shrinking? I don’t know, but it is definitely less sensitive and the bursa is no longer irritated or inflamed.

UPDATE VI (January 2, 2013) I thought I’d better update again rather than waiting to share some additional information as well as the good news that followed the 2-hour and 5 minute run the other day. I really feared that I might be hobbling around the next day after sharing the news on my blog. Amazingly not only was I OK the next day, I felt good enough to run an hour. Even more amazing is the fact that I ran the next day (at a brisk pace – thanks to my fiance 🙂 and the next day. I’m taking tomorrow off regardless of how I feel but I’m thrilled to have covered 40 miles in 4 days – especially since one of those days included that 2 hour run.  Something else I wanted to share that I’ve done differently this past month was lacing my shoes differently from each other. My right foot is my Haglund’s foot – and the right shoe is the one I wear the heel lift in because of my leg length difference. My left foot has a tendency to turn out when I run so I’ve recently been lacing it at the top shoelace hole to keep that foot under greater motion control while lacing my right shoe at 2 holes lower so it is less restricted. I think this has helped – if not my Haglund’s than at least my gait. I’m a neutral runner so I don’t need motion control shoes in general, but this helps with the discrepancy between my right and left feet.

UPDATE VII (April 26, 2014) I can’t believe it’s been more than a year since I updated this post. Suffice it to say I got married last year and planning the wedding took much of my time and attention. I’m happy to report my Haglund’s Deformity continues to be less and less of an issue. I’ve been able to go back to wearing a 7mm heel lift in my running shoes which is what works best for my back (my leg length discrepancy is a result of an ideopathic scoliosis). This morning I asked my husband if we could take a tandem bike ride instead of run together as I suddenly realized I’ve been able to run every day for 3 weeks straight without foot pain! These 3 weeks included a 2-hour plus run and other longish runs and 2 high intensity hilly runs with him. I’m also less plagued by the oxalate pain (muscle cramping, etc) that I’ve written about as it’s been almost 12 months since I reduced my oxalate consumption after realizing that it was contributing to my joint and muscle pain. I’m now contemplating taking up a dance class (tap anyone?) – something I’ve sorely been missing –  as I think my Haglund’s can tolerate it. As we were riding our tandem this morning I was just thinking “I’m so glad I didn’t have surgery for my Haglund’s 3+ years ago when I was scheduled for it”. While I will always have a large bump on the back of my right heel, right now it is quite manageable and largely forgettable.  By the way, I’ve stopped taking the Osteoheel as I found that it was causing some pain when I took it. This started happening after I reduced my oxalate consumption – so there may be some connection there. One product that has helped me tremendously is Magnesium Malate (I take capsules by Source Naturals). Again, I think this is helping the oxalate condition, but my Haglund’s may be connected because it seems to help that, too.

UPDATE VIII (May 25, 2015):  Wow – I can’t believe another year has passed since I did an update for this post. I guess I’ve been busy. And, if you read my blog regularly, you know that about a year ago I broke my elbow – so needless to say other health concerns became more pressing. I’m happy to report that my Haglund’s continues to be manageable as long as I wear the right shoes and listen to my body. I’m back to taking the Osteoheel – but only as needed and only in tiny amounts (I typically cut it in half and take only half at a time). I’m not currently taking the Magnesium Malate unless I start dumping oxalates and then I only take it while that’s occurring. I found that if I take it when I don’t need it it actually causes muscle cramping in me!  I get a lot of magnesium in my diet so that’s probably a sign that I only need it in certain circumstances. Often when we get too much of a supplement our bodies react by making our symptoms worse. All for now…


All for now…..

Be Well,


Using the Pool As a Cross-Training Tool

July 29, 2010

Thanks to those of you who attended my talk at Fleet Feet/Runner’s High in Menlo Park, CA.  Below is a summary of some of the key points we covered. Also please visit my website at for  even more information.

As we all know, sports-and fitness-related injuries are all too common. Fortunately, the water is an ideal environment for athletes to not only rehab their injuries, but also maintain or even increase their conditioning and improve their performance. In fact, the biggest misconception about aquatic cross-training is that it’s only useful when injuries prevent land-based workouts. Instead, the pool can be a valuable, year-round cross-training tool for almost any sport or fitness activity.

Aquatic cross-training not only keeps you cooler in the Summer months, it provides an intense, no- or low-impact, pain-free workout. It is the perfect complement to running, tennis, basketball and other high impact physical activities.

The following are just a few reasons why:

•     RESISTANCE: Water provides 12 times the resistance of air in every direction, allowing you to determine the intensity of your workout by the speed and range of motion of your movements.

•     MUSCLE BALANCING: Exercising in the water necessitates that you work both halves of each muscle pair (i.e. hamstrings/ quadriceps) equally. This works to balance the strength and flexibility of opposing muscle groups helping to prevent injuries.

•     HYDROSTATIC PRESSURE: When you are exercising vertically in the pool, the hydrostatic pressure of the water increases your venus return or the rate at which your blood is pumped back to your heart, allowing your heart to work more efficiently. This means that your heart rate is roughly 10-15 % lower in the water compared with exercising at the same intensity on land, so you can really push yourself in the pool.

•     OFFERS NO- OR LOW-IMPACT ENVIRONMENT: Because the buoyancy of the water offsets gravity, deep water offers a non-impact, virtually injury-free environment in which you can exercise regularly  at a high intensity. Even while exercising in shallow water – at chest-level you’re only 35% of your body weight and waist-deep – only 50%.

•     INCREASES RANGE OF MOTION (FLEXIBILITY): The natural buoyancy of water helps increase range of motion of joints and muscles, enhancing flexibility.

•     IMPROVES BALANCE/COORDINATION: Vertical aquatic exercise – especially deep water exercise – improves your overall balance and coordination by challenging you to maintain a vertical body alignment in the unstable aquatic environment.

•     CORE CONDITIONING:  Just maintaining this upright posture much less exercising in deep water challenges your core muscles without loading your spine. There are also many core-specific exercises you can do in the pool.

•     UPPER BODY WORKOUT:  Unlike running on land, running in the pool offers you a great upper body workout because of the resistance the water provides.

•     SPORT SPECIFIC:  Unlike swimming, exercising vertically in the pool – (whether in the shallow or deep end) can be a much more sports-specific means of cross-training for runners.

By the way, you don’t have to be a proficient swimmer (or even know how to swim) to cross-train in a pool. I’ve worked with many non-swimmers who nevertheless came to enjoy aquatic exercise (even in deep water!).

Be Well,


Mobility vs. Stability: Achieving a Balance

July 3, 2010

As an aquatic therapy specialist, I often speak to my clients of the dichotomy between gravity and buoyancy. Equally important is striking the right balance between mobility and stability. I see this all the time with new clients. Some are very flexible, but lack strength and stability, so they’re frequently injured. Others are strong and stable, but lack flexibility which can lead to muscle and joint stiffness and sometimes injury.

Mobility is defined as the range of uninhibited movement around a joint. Joint Stability is basically the ability to maintain or control joint movement or position. Stability is achieved by the coordinating actions of surrounding tissues and the neuromuscular system.

Fortunately, an imbalance between mobility and stability can be overcome through consistent, quality training. Aquatic yoga, tai chi and Pilates, for example, are wonderful for increasing both flexibility and core stability and land-based yoga and weight training is very helpful in enhancing overall strength and stability of muscles, ligaments, tendons and joints.

This is one of the reasons why it’s so important to incorporate a variety of physical activities into your fitness program. Unfortunately, most people tend to gravitate toward what they enjoy – and that’s usually what they’re good at, not necessarily what they need to improve upon.

Establishing a balance between the need for stability in some of the major joints of the body and mobility in others is critical for healthful, pain-free movement. For example, the lumbar spine needs stability which the hip joints need to be mobile. The knee joints, on the other hand, need stability, while ankles need mobility. Think of a race walker – whose hips swivel back while their knees are very stable, with very little flexion. In fact, one of the rules of race walking is to keep one knee straight at all times – which requires hip mobility. The lumbar spine also requires stability to keep the race walker’s form.

Finding an ideal balance between stability and mobility is not just important with the physical body, but also in living life itself. Flexibility without stability can be a bit reckless, while too much stability without spontanaity, leads to stagnation and boredom.

Be Well,


Anti-Gravity Treadmill? Just Run In Deep Water

January 26, 2010

A few years ago I had the opportunity to try a prototype of a new anti-gravity treadmill that was originally developed at NASA Ames Research Center for astronauts. Now a newer, “cheaper” model developed by AlterG is being marketed to physical therapy clinics, athletic departments, hospitals and even nursing homes.

This device features a pneumatic , “un-weighting device” that uses air pressure to counteract body weight during exercise, allowing users to walk or run without impact or pain. Basically, the AlterG treadmill contains a bag-like waist-height enclosure that you zip yourself into. The enclosure is then inflated to reduce the force of gravity on your legs up to 80 percent. Injured athletes can use it to continue training while reducing forces on tendons, muscles and bones, gradually increasing the impact during the healing process. The AlterG can also be useful in helping older adults recover from a broken hip or femur or to re-learn gait training after a stroke without the risk of falling.

But why rely on this expensive new technology when the same benefits can be had in deep water? For,  at $24,500 per machine, this anti-gravity treadmill is cost-prohibitive for most individuals and is even a luxury for most rehab centers. Actually the AlterG is similar in price and concept to an underwater treadmill. I was fortunate to be able to use an underwater treadmill in my work as an aquatic therapist at Canyon Ranch in Tucson, AZ. But, again, a much more cost-effective and versatile way of rehabilitating injuries and facilitating healing is to head to the deep end of the nearest swimming pool (preferably a warm pool).

The best, most natural anti-gravity training can be performed in deep water wearing a flotation belt. Aquatic athletic conditioning and rehab is an ideal and inexpensive way for injured athletes and others to restore range of motion and maintain strength of  joints, muscles, tendons and bones. The buoyancy of the water supports joints and muscles and warm water promotes circulation and relaxation, while reducing pain and tension. Individuals with a wide variety of acute and chronic musculoskeletal conditions can benefit from everything from very gentle therapy to an extremely vigorous, non-impact workout. Race horses have actually benefitted from deep water therapy for decades. In fact, today they even make underwater treadmills for horses! Human beings are finally realizing the benefits of deep water training, too.

Be Well,


Aquatic Tai Chi: All of the Benefits and More

August 19, 2009

As an aquatic therapist, I frequently witness the freedom warm water gives individuals who are unable to move with ease on land. One form of land exercise that lends itself beautifully to the pool and actually offers some advantages in an aquatic environment is tai chi. In fact, one form of aquatic tai chi, called “Ai Chi“, was specifically designed for performing in a warm pool. As such, it takes advantage of the water’s properties, fostering range of motion while challenging balance (safely) and facilitating core strength and stability.

Developed by a Japanese swim coach, Jun Kunno  and aquatic therapist, Ruth Sova, Ai Chi literally means “flowing aquatic energy”. The series of movements is simple, but effective and becomes meditative when performed repeatedly and coordinated with the breath. I’ve had the pleasure of doing Ai Chi with as many as 50 people in a large swimming pool at an aquatic therapy conference. Believe it or not,  it can even be meditative in a group that size when everyone is in sync. I love teaching it to my clients and it’s a great way to conclude an aquatic therapy or aquatic fitness session.

Water Tai Chi incorporates more traditional tai chi movements and translates them to an aquatic environment. Like Ai Chi, Water Tai Chi combines the mind/body benefits from traditional tai chi with the gentle, freeing, flowing environment of the water.

One important component of aquatic tai chi is the temperature of the water. The temperature for both Ai Chi and Water Tai Chi should be a minimum of 86 degrees farenheit. This allows for slow, relaxed movement and increased blood flow to joints, tendons, muscles and ligaments. Contact your local YMCA or the Arthritis Foundation to see about classes offered in your area.

Be Well, 


Aqua Pilates: Training Your Core in the Pool

June 16, 2009

Recently I blogged about the benefits of aquatic yoga. Pilates is another form of exercise that can be performed very effectively in the pool. While Joseph Pilates probably never imagined his principals being applied in an aquatic environment – pilates and the pool are natural bedfellows. 

The Pilates Method is unique in that it offers resistance (primarily of the abdominal, low back and buttocks muscles) and flexibility training simultaneously. Pilates also enhances spinal alignment, coordination, balance and body awareness. Furthermore, by fostering bilateral strength and flexibility of opposing muscle groups, Pilates exercises both help prevent and rehabilitate injuries.   

Most of the “Pool” Pilates exercises I teach incorporate the buoyancy of the deep water with the natural resistance of the water. My clients can modify the difficulty of the movements by controlling the range of motion and speed of their movements. I have them wear a flotation device and hold one or two  buoyant barbells for upper body stability in order to isolate their core muscles.

Core conditioning is even more challenging in deep water when there is no gravity to provide stability. Just remaining upright in deep water demands co-contraction of back and abdominal muscles. When this “core-stable” deep water posture is combined with movement, the trunk muscles are further challenged. At the same time, because the exercises are performed without gravity, there is no loading of the spine.

Take your Pilates or other core conditioning workout to the pool this summer. You can cool off and improve your core fitness all at once.

Be Well,


Aqua Yoga: Go With the Flow

May 28, 2009

This new fad – anti-gravity yoga has me a bit stumped. Participants precariously hang from the ceiling in harnesses while simulating yoga poses. In my opinion they would be far better off trying aquatic yoga. By taking your practice to a warm pool you’ll reap even greater benefits by “off-loading” your musculo-skeletal system while performing yoga postures.

While the buoyancy of the water allows you to increase your range of motion, it also creates an unstable environment where your core and posture are constantly challenged. As a result, the water fosters both flexibility but also stability. Furthermore, for those for whom land-based yoga is prohibitive due to arthritis or injuries, the water offers a wonderful alternative.

My favorite yoga flow sequence involves using a noodle in the shallow end to simulate camel pose, child’s pose, head-to-knee pose, gentle spinal twist  and even upward dog. Other postures that lend themselves beautifully to the water without the aid of a noodle include:  triangle pose, extended angle, eagle pose, dancer’s pose, half moon and tree pose. 

As summer approaches, try taking some of your yoga postures out of the studio and into the pool!

Be Well (and Namaste),


Aquatherapy, Salmon & Traumeel: My healing miracle workers!

March 7, 2009

A few days ago while working in the pool with an aquatic training/therapy client, I got too close to the wall in the deep end and kicked the heck out of  the metal ladder, smashing my second and middle toes and traumatizing my entire foot!!  By that evening, my foot was purple and so swollen I had trouble putting on a shoe!

Seriously, my foot resembled a plump piece of eggplant. Needless to say,  I started to freak out and was pretty certain I’d broken at least one of my phalanges (the small bones in the toes). After limping around much of the rest of that day I decided to put my wellness coach hat while simultaneously becoming  my own client.

So what did I do?  I took my advice and slathered on Traumeel – a homeopathic anti-inflammatory that I recommend to many of my clients – 3 times a day. I also tweaked my diet to include even more healing foods, including salmon, flax oil, chia seeds and lots of vegetables, especially broccoli and celery to reduce inflammation and collard greens for calcium and vitamin K (in case I had broken the bones).

The third key to my healing was spending time exercising with clients in the deep end – without putting any weight on the foot. Moving in warm water helps to pull edema out of the body and increase range of motion of the joints, muscles and tendons. So after a few hours of working in the pool, the swelling in my foot had significantly decreased and I was even able to bend my toes a bit without pain.

I’m happy to report that  48 hours later, my eggplant foot is now nearly back to its usual pale, bony state. I’m walking without much pain and able to wear a normal shoe. Fortunately, I don’t think I’ve broken, rather  just badly bruised my toes. Anyway, this latest trauma was yet another reminder of the incredible healing power of the body – if given the proper tools.

Be Well (and Be Careful!),


You Don’t Have to Know How to Swim to Enjoy Aquatic Exercise

February 7, 2009

Are you a non-swimmer who never goes near a swimming pool, lake or ocean? You’re not alone  – many adults never learn to swim for a variety of reasons.

One of my clients, “Pat”, never learned to swim because her mother feared water and wouldn’t let Pat take lessons. Other clients had traumatic aquatic experiences and were never able to release their fear of being in water. Personally, I nearly drowned twice before I was 2 years old, so I know what it’s like to overcome a fear of water. Ironically, today I make part of my living working in the deep end of a warm swimming pool.

As an aquatic therapist I’ve worked with many non-swimmers who bravely recognized the benefits of aquatic therapy and exercise and overcame their fears enough to exercise in water (even deep water – wearing a flotation belt). Most of them eventually took lessons to learn to swim after growing more comfortable in an aquatic environment.

The warmth of the water is an important component in encouraging non-swimmers to relax in the pool. A warm pool (86F or warmer) facilitates the relaxation of body and mind. That’s also one of the reasons I recommend adults learn to swim in a warm pool.

One of my former clients in Tucson, “Jane”, came to me after tearing her lateral meniscus on the tennis court. A non-swimmer, Jane nevertheless agreed to try rehabbing her knee in the pool with me in an effort to avoid surgery. Much to her surprise and delight, Jane not only  overcame her injury through our work in the pool, she kept up her aquatic sessions post-rehab as she found they provided an excellent way to cross-train with her tennis.

It’s never too late to enjoy the benefits of aquatic exercise and, more specifically, it’s never too late to learn to swim. The Miracle Swim Institute in Berkeley, CA has been extremely successful in their mission to help adults overcome their fear of water and enjoy swimming. If you don’t live in the Bay Area – the Institute has a network of MSI-trained instructors in other states. Many YMCAs also have adult-focused swim classes conducted in warm, shallow water pools with caring, patient instructors. The Palo Alto Family YMCA program is one example in the Bay Area.

So, if you’ve never learned to swim – or you don’t feel confident with your current swimming skills – make an effort to conquer your fear by getting involved in some form of aquatic exercise. The more time you spend in the pool, the more comfortable you’ll become and the more you’ll develop the necessary skills to become a competent, confident swimmer. And, as you reap the benefits of aquatic exercise, I guarantee you’ll enjoy the process! 

Be Well,