Correct that!

Hi all!  We want to discuss corrective exercise this week.  Both of us have our specialty certification for Corrective Exercise from NASM.  This allows us to perform certain assessment that help to identify incorrect movement patterns and postures as well as the possible muscle imbalances that may be the cause.

Some of the most incorrect postures and movement patterns we see at Bay Area Pain and Wellness are:

  • Forward head position
  • Protracted shoulders
  • Flattening of the lumbar region, especially when seated
  • Knee valgus
  • Feet externally rotated

While those are the most common, they are by no means the only positional issues that we may be able to correct.  Many times these issues cannot be corrected due to deformities within the bones.  However, when it is a muscular issue, we are able to identify the culprits through some assessments that help us to narrow down the area and further to specific muscles.

The most common assessment is called the overhead squat assessment.  With this assessment, we are looking at the whole body.  Each view we use, we are looking at specific checkpoints.  We have the client move through a squatting activity with four specific caveats:

  1. Arms up with feet flat
  2. Arms up with feet elevated
  3. Arms down with feet flat
  4. Arms down with feet elevated

During the assessment, we are watching for:

  • Feet rotating
  • Knees moving inward or outward
  • Rounding or arching of the back
  • Arms dropping
  • Heels raising
  • An asymmetrical shift during the squat

Any of these are indicative of muscle imbalances and through the use of the various positions and checkpoints, we are able to pinpoint where the imbalances are.  Once we have discovered the areas needing work, we can begin using corrective activities.

In the picture above, you can see that when compensation was removed, the knees and feet lined up but there still seems to be a slight asymmetrical shift  that needs further assessment and will also need to be corrected.

Correcting involves:

  • Inhibiting overactive muscles through self myofascial release
  • Stretching overactive muscles
  • Activating under-active muscles

Corrective exercise is something that should be undertaken:

  • After a long period of no exercise
  • Periodically during regular exercise to ensure proper movement patterns
  • Post rehab of an injury
  • Post sport season

Here is a scenario:

A 43-year-old former dancer comes to the clinic complaining of knee pain.  Upon observation of her walking gait, we notice her feet are externally rotated.  We perform the overhead squat assessment and notice that as she squats, her feet will move outward with her feet flat on the floor with her arms up or down.  However, when we place her heels on a board that allows a 2-inch lift, her feet no longer rotate.  We conclude that the culprit is most likely her lateral gastrocnemeus is overactive and her medial gastrocnemeus is under-active on both legs.

The plan for this client is to foam roll and static stretch her lateral calves followed by strengthening of her medial calves.  This would be added into an exercise plan that would be designed to stabilize her whole body prior to advancing to a strength endurance program.

While the overhead squat assessment is an excellent first step, there are several other assessments that we will use to correct compensatory movements and imbalances.  This post only described one specific assessment that we use.

Corrective exercise is an important step in helping yourselves in proper alignment and using proper movement patterns.  It will help to reduce the risk of injury and will stabilize your joints.  We highly recommend you find a personal trainer certified to perform these types of assessments to give yourself the best chance to succeed in your personal fitness goals.

Home Exercise Program for Knee Injuries

This is part II of our Blog on the anatomy of knee’, knee injuries and exercises to strengthen, stretch and self massage.

Before participating in any exercise program, it is best to consult with your doctor.

When you think about strengthening your knee you must think beyond simply machine strength training. In fact, none of the exercises we will show you here today involve machines. We will show you a balanced exercise program which will include strength training of all the muscles that play a part in keeping our knee strong (hips, quads, hamstrings, calves) as well as stretches to relax them and massage techniques to reduce trigger point or muscle tension. It is best to do all three of these techniques and not just stretching or strengthening as it will create muscular imbalances of which will lead to compensatory movement patterns.

First we will discuss stretches and self massage techniques. We will then split exercises from beginners stage exercises and moderate stage exercises. These will differ in difficulty and if you feel you need higher level exercises, send us a comment.

A good 20-25 minute cardio warm up would be great prior to or following your exercises. Stationary bikes are great for knee range of motion but make sure you are not too close or too far from the pedals.


 Hamstring stretch- opposite knee bent to provide support for lumbar spine. Hamstring stretch performed using a stretch-out strap (can be substituted with belt or towel). Keep knee straight and gently lift leg up. Once you reach a nice stretch (not painful) hold 30 seconds and repeat 3 times on each leg.


 Quad/Hip flexor stretch- opposite knee bent to provide support for lumbar spine. Scoot to edge of bed or sofa and slowly allow leg to hang. If you want to feel the stretch more, simply move your heel backwards little by little until you reach desired stretch. Hold for 30 seconds and repeat 3 times on each leg.

 Calf stretch- point your back toes toward the heel of your front leg. Allow heel on back leg to slowly rest on floor and hold stretch for 30 seconds, repeat 3 times on each leg.


 Yes we are using a rolling pin. When you get creative with your tools, the opportunities are endless. Gently massage your thigh muscle (Quad). You can glide the pin along your inner thigh, mid thigh and external thigh. Do not roll over your knee. Only massage muscle, not bone.

 Keep your back straight as marked with a yellow line in the picture. Softly massage your calf muscle with the rolling pin. You can glide the roll over the inner, mid and outer calf muscle.






Calf massage using a foam roll- place calf below knee line and using your arms, lift and roll towards your ankle and back to below the knee line. Make sure you maintain your shoulder in a safe place by not allowing your wrist to go behind your shoulder. My wrist is below my shoulder.



Hamstring massage using foam roll, place the foam roll below your gluteus muscle and use your arms to lift your body weight and roll towards the back of your knee stopping before the joint line. Again, make sure to maintain your shoulder in a good position as mentioned above. 







 Gluteus massage- bend your opposite knee and using your arm strength and your opposite leg to roll you forward and back massaging trigger points along your butt muscle.



IT Band Massage- I will not lie to you, this one is intense but equally important to do. Cross your opposite leg over the leg that will be rolled and using both arms and your bent leg to slowly glide you from the top side of your hip down to just above the top side of your knee. This band tends to get tight and will feel intense as you roll it.




Quad massage- Keeping your elbows beneath your shoulders, slowly glide your body’s weight from the top of your quad to just above your knee and repeat. Do not roll over your knee joint. 









Hip Strengthening- Start off without the elastic band and if it is to easy you can always add a resistance band to increase the intensity of the exercise. Keep your hip in alignment with your shoulder. Keeping your feet together, slowly lift your knee up separating your legs and slowly return to starting position. Key word: Slowly

10 x 3 each side. 






 Hamstring Curl– Lying face down, slowly bend your knee bringing your heel towards your butt and slowly return to starting position. Key word: Slowly                                         10 x 3 each side and if it is too easy you can add an ankle weight for resistance.

Terminal Knee Extensions- use a foam roll or a pillow if you do not own a foam roll. Place the foam roll beneath your knees and keep your back straight against the wall. Slowly lift one leg at a time and squeeze your quad muscle at the top of the exercise. Hold for 3 seconds and repeat 10 times. Switch legs and repeat these steps a total of 3 times. When you do this exercise, you may feel a stretch on your hamstring. 






 Seated Calf Raises- sitting with good posture, you may add resistance to this exercise by gently pushing down on your knee as you slowly raise your heel up and slowly return it to the starting position. Key word: Slowly. Repeat 10 x 3


 Standing Hip Strengthening- Use a resistance band if you want the exercise more challenging and remove it to make it easier. Place the band above your knees and while maintaining good posture and body alignment side step 5 times to the right and 5 times to the left. Repeat 3-5 times. Make sure the top half of your body does not sway side to side as you step. The only part that should be moving is your lower half. Do not drag your feet and use slow and controlled movements, not allowing the resistance band to pull your legs.

 Quad Strengthening- Leaning against an exercise ball, have your feet out in front of you. Slowly squat down as you lean into the ball and avoid having your knees pass your toes. We have added a yellow line for you to see how to maintain your knees in a safe position as you squat. When you slowly stand to starting position, do not extend your knees all the way, keep them slightly bent. Repeat 10 x 3

 Standing Heel Raises- using a stepper or a stair, place only your toes on the step allowing your heels to hang off the edge. You may use a wall for balance if you need. Slowly raise onto your toes and slowly return to starting position. If you want to make this exercise more challenging simply hold the exercise at the top of the heel raise for 5 seconds before slowly returning. Repeat 10 x 3


Bridge with a Hamstring Curl- This exercise will work your hamstrings as well as your calves, glutes and core. Lie down on your back placing the ball beneath your feet. Slowly raise your butt off the floor and hold the position as you press into the ball with your feet. Slowly begin to curl the ball towards your butt but make sure you maintain proper alignment of your back by tightening your core. Slowly return the ball and lower your glutes back down to the floor. Repeat 10 x 3 make sure you are properly breathing through this exercise as it is more challenging.


There ya have it! A solid start to a great exercise program to strengthen your knees. If you want to get creative with it, set up a mini circuit for yourself using the exercise mentioned above. This will keep you moving from exercise to exercise and when you are finished with 1 round you can repeat it 2-3 more times.

We hope you enjoy this wonderful exercise program and look forward to any comments you have to give.

Until next time!

Anatomy and common injuries of the KNEE

Our knees are hinge joints which consist of two joints; tibio-femoral and patella-femoral joints. The key to stability in our knees is through our ligaments. The most important structure of the knee is the menisci which is made of cartilage which of course with time can wear and tear. Our knees are also composed of muscle, nervous, osseous and connective tissue structures.  The parts of the knee that are most commonly injured are the following:

– Patella/Quadriceps tendon

-Hamstring tendon





– IT Band

-Medial or Lateral Menisci

– Retro patella Surface

There are several factors that can play a role in knee discomfort, pain or instability. We will name a few:

  • Normal aging process creates normal wear and tear
  • Sports related injury
  • Accidental injury/ trauma
  • Improper body mechanics with everyday activities

Lets spend some time talking about different knee injuries. Part 2 of this blog which will be published next week will discuss how to strengthen your knee joints.

Normal Aging Process

As with most things in life, over time things wear down. Our bodies have no shield against this very normal process that happens with everyone and almost everything in life. Think tires, clothes, pets, carpets, window shades, canopies, etc. Over time all of these items will wear and tear and may eventually require repair or replacement. However, you can extend the life span of these things, including your knees and all joints if we take care of them and keep them nice and strong.

Sports related Injury

The most common way to injure your knee is to plant your foot and turn or pivot. Speaking from personal experience, my sister tore her ACL and Meniscus during a basketball match when she decided to turn while leaving her foot planted. “POP!” is what she heard and when she tried to get up, she fell right back down. Her knee lost its primary stabilizer the moment her ACL tore. She went on to require surgical ACL and Meniscus repair only to re-tear it again 5 months later and require a 2nd surgery; all before she even turned 18 years of age.

When one plays sports you assume all risks that come with it which include the possibility of injury. With the simple act of jogging one creates an impact force on our joints especially the knee. As your foot hits the floor, the impact of the ground (harder the surface greater the impact) goes from your foot and through your joints. The stronger your muscles are that surround your joints the more impact is absorbed through your muscle vs joints. Hence, the stronger your muscles the more protection your joints have. Think of your muscles as your joints’ body guards! Who do you want protecting your joints?

*Caution, this could be a trick question *

Weak and atrophied        

photo credit;          

   Toned stabilizers                         

Photo credit;

   Big and Bulky

photo credit; muscle and fitness


The answer is: you want a good combination of both Captain America and The Rock and we will explain why during the “how to strengthen part of this blog”. So, keep on reading. However, there is also a right way to strengthen and a wrong way to strengthen. We will discuss the best most proper way a bit later.

Accidental Injury/ Trauma

In life, there are some things we cannot avoid no matter how much we try to take care of ourselves. Another personal example, my brother was out at a dog park one nice sunny day when all of a sudden, a dog who was being chased by another dog came at him from the side and ran right into his knee knocking him straight to the ground. In the process, the blunt force trauma of a dog running at full speed caused significant damage to his knee requiring him to undergo a total knee replacement. We happen to work in a clinic where the majority of the patients are worker’s compensation clients, meaning they were injured in an accident at work.

There may be a time that a fall, car accident, work accident, etc., may be to blame for the pain or discomfort in your knee.

Improper Body Mechanics

If we repeatedly perform activities, job tasks or every day life errands using improper body mechanics, this can also lead to accelerated wear and tear on your joints; especially your knees.

If you bend down to pick up an object from the floor using poor mechanics such as in the picture below, you are adding additional pressure to your knees.

By simply making a few corrections to how you perform this task, you can greatly reduce the wear and tear to you knee and in the end, protect your joint from possible damage or the need for surgical repair in the future.

Another example is how you go up the stairs. Again, as seen in the picture to your left in comparison the picture on your right you can see that the changes are small yet the pressure in the knee is minimized by simply performing the activity slightly different.

INCORRECT                                              CORRECT 

A good analogy is the wheel alignment on your car.  If you have good alignment, the wheels wear evenly and last a long time.  If they have poor alignment, the wheels will wear down quickly along the sides or edges and will need to be replaced much sooner.  The same holds true for your knee or and joint for that matter.  If you are using improper posture or body mechanics, you are basically out of alignment and are wearing down on the tissues faster.  In general, if you can keep your knees from passing your toes, you are in a safe more recommended position.

Photo credit; Post Rehab MES course




When In Doubt, Sit It Out!

This week, we will discuss concussions.  With football teams starting conditioning camps soon, it is a subject to shed some light onto.  We have all seen how professional sports are taking serious steps to reduce the rate of concussions and to properly care for those who have sustained concussions.  Almost a year ago, I completed my Master’s degree with a capstone paper on concussions in football.  In the paper, I compared American football to rugby union.  The rules in rugby are designed to minimize contact with the head.  They are taught to tackle in a way that minimizes contact to the head.  But does this prevent concussions?  Absolutely not!

Can we prevent concussions?  Absolutely not!  Let’s not kid anyone.  Accidents happen.  Stuff falls and hits you in the head.  Bats slip out of players’ hands.  Balls are thrown offline.  Low lying branches.  Slippery rocks.  There are too many ways that injuries can happen without even being involved in a sport that involves collisions between bodies or the body and the ground.

Next question: do you have to get hit in the head to cause a concussion?  Absolutely not!  A sudden change of momentum and/or direction that causes your brain to jerk around in the protective fluid inside your skull can cause a concussion.  Consider a receiver running full speed, looking back at the ball coming, puts his hands up to catch it, when suddenly a strong safety comes across at full speed and hits the receiver straight in the chest knocking him backward.  The conditions of this, especially head turned and the sudden change in momentum/direction could cause a concussion.

I was hit in the head hard but did not get knocked out.  I felt dizzy and had a headache but don’t have a concussion because I remember everything and was never knocked out, right?  Wrong.  Loss of consciousness (LOC) is not a determining factor with concussions.  The list of signs and symptoms provided later is useful.

Do helmets help?  Yes and no.  There are studies that show that when someone puts a helmet on, it tends to give them more confidence and a feeling of invincibility.  In my paper, I found a study looking specifically at rugby players and “scrum caps.”  These are caps that are soft sided and help to reduce the risk of lacerations and rubbing injuries to the ears or head in the scrum.  Finch, McIntosh and McCrory (2001) studied how the players felt about wearing them.  The main points to take from the results are:

  • The players felt that the “helmet” would prevent concussions
  • The players felt safer
  • The players played more aggressively

In rugby, using the head as a main point of contact by the tackler or as the primary target on the ball carrier is a major infraction.  American football has taken big steps to eliminate or at least significantly minimize head contact.  “Targeting” has become a major infraction and can get a player ejected from a game.

This brings me to the next point and it’s something I tell players: the helmet is meant only as protection in case things do not go perfectly.  Things will not go perfectly.  The helmet is not a weapon.  The helmet is not designed to allow you to use your head as a primary point of contact.  It is merely a safety piece of equipment in case you get hit in the head.

But, I have seen helmets that are designed to break apart with hard impacts to prevent concussions.  Correct, the helmets are designed to break apart with significant impact.  Is it designed to “prevent” concussion?  Nope.  It is designed to reduce forces that can cause a concussion.  If a helmet breaks apart, rest assured, the impact was significant and there is likely a concussion or worse.  Precautions must be taken.

This brings us to the point of what to do if you suspect a concussion.  If you or someone you know has fallen, hit his head, was hit in a game, etc. and you notice dizziness or headache immediately or shortly thereafter, this is enough for doubt.  It’s time to start paying attention.  Here is a concussion checklist:

Scoring on this table:  0=none, 1-2=mild, 3-4=moderate, 5-6=severe

Symptom 0 1-2 3-4 5-6
1.      Headache        
2.      Pressure in head        
3.      Neck pain        
4.      Nausea or vomiting        
5.      Dizziness        
6.      Blurred vision        
7.      Balance problems        
8.      Light sensitivity        
9.      Noise sensitivity        
10.   Feeling slowed down        
11.   Feeling in a fog        
12.   “Don’t feel right”        
13.  Difficulty concentrating        
14.  Difficulty remembering        
15.  Fatigue or low energy        
16.  Confusion        
17.  Drowsiness        
18.  Trouble falling asleep        
19.  More emotional        
20.  Irritability        
21.  Sadness        
22.  Nervousness or anxiousness        

Moses (2012)

This is a nice tool to have, but anyone who suspects a concussion should be checked by a medical professional.  We provided this to help you all understand the numerous signs and symptoms to watch for.  Again, if you suspect a concussion, please get checked.

We will get specific to football as that season is sneaking up on us.  In California, we are required to have an ATC or an MD on the sidelines for injuries.  I do not know the laws of other states but I would assume (hope) that they have similar laws.  If the ATC at the high school where I coach suspects a concussion, he will immediately take the player’s helmet.  This makes it so the player cannot return to the game.

Hopefully, football programs are catching on to the professional level and making the proper changes and talking to their players about being honest about their symptoms.  If you have kids playing sports and the sideline medic reports possible concussion to you, please follow his or her instructions closely.  And – When in doubt, sit it out!

If you have any questions or comments, please comment below.  We are happy to help!

Finch, C.F., McIntosh, A.S., McCrory, P. (2001). What do under 15 year old schoolboy rugby union players think about protective headgear?  British Journal of Sports Medicine, 35, 89-94.  Retrieved from: on July 20, 2017

Moses, S. (2012). Concussion symptom checklist.  Retrieved from: on July 20, 2017

How N.E.A.T.!!!

We have discussed a variety of topics thus far.  Those discussing exercise are specific to going to a gym or performing some sort of sport-like activity.  This means the person actually sets his or her mind to perform “exercise” for a certain period of time.  But what about the rest of our days?  Do the activities performed throughout our day have any bearing on our well-being?  The short answer is yes.  We will give a slightly longer answer.

N.E.A.T. is an acronym for Non-Exercise Activity Thermogenesis.  So, now that you know that, just call it “NEAT.”  It’s a lot easier to remember and to say.  But, what the hell is it?  Well, it’s the activities we do that are not when we are doing our “exercise.”  Walking to places, walking between buildings at work, taking the stairs, dancing, etc. are all examples but not nearly the complete list!  Think about when you were a kid.  How often did you say, “I’m going to go for a jog” versus calling your friends and getting a pick-up game of basketball of football?  While those are exercise and sport-like activities, they are a bit different than what we typically call “exercise.”  As adults, we will literally say, “I need to exercise” and pick up the phone and call a friend to go shoot the basketball around.

Now consider those days and how much energy you had.  I never seemed to run out.  It drove my parents nuts!  And I would eat any food that entered the house!  My energy intake sure seemed to be far higher than my output in my eyes.  I never really felt like I was expending a lot of energy.  We walked or rode our bikes everywhere!  And when we got to where we were going, there were no video games.  We didn’t just plop down and start a fake basketball game on the TV in front of us.  We stayed active!  We just constantly expended energy and our bodies were up to the challenge because they adapted to it.

A study by James Levine and colleagues (2006) goes into detail on how effective NEAT is on our daily energy expenditure.  In reading the study, I could not get over one small portion.  In the section labeled “Variance in Leisure-Time NEAT,” the authors give an example of an office worker who comes home and reclines while watching TV maybe during the hours of 5:00-11:00.  They have already established in the study that there is a resting energy expenditure and they are basing measurement from that.  During the 6 hours he reclines and watches TV, his energy expenditure (EE) is around 8% above his resting.  They compute this to be approximately 30 Calories expended for the evening.  Not a lot!

Now they pose the scenario that he needs to paint a bedroom, pull weeds, and cycle to and from work.  They point out that this becomes the equivalent to walking approximately 1-2 mph for that same 6-hour period increasing the NEAT to 750-1125 Calories for the evening.  This means that by incorporating NEAT into his daily life, he can potentially increase his daily EE by 1000 Calories per day!!  PER DAY!

It takes about 3500 Calories to burn 1 pound of fat.  The last 5K I did took me just over 24 minutes and I burned about 750 calories (according to my exercise tracking app).  If I rely on my running regularly as my primary energy expenditure I can expect that I am not going to burn fat very quickly.  If I run regularly but also add in a reduction in use of my car (walk, ride my bike, etc.) and take the stairs instead of the elevator every day, I can significantly impact my daily EE and therefore help with weight management.

I can say in all honesty, when I get home from work, I am tired.  The last thing I want to do is to pull weeds or paint a room.  Then again, my work involves me being on my feet most of my regular work day, usually followed by coaching football.  I get to the Bay Area Pain and Wellness Center, I can either take the elevator 2 floors up or I can take the stairs.  I choose the stairs every time.  So, I am on my feet or 10-12 hours already.  I do work in my garden a little when I get home.  Then, it’s rest time for me!  I am sure I can find a way to add some more EE to my day; especially during the football offseason.  But the point is, there is always a way.

So, the question now posed to you is: How will you increase your daily energy expenditure?

If you choose to be outside for you increased EE, please wear your sunscreen!


Levine, J.A., Vander Weg, M.W., Hill, J.O., Klesges, R.C. (2006). Non-exercise activity thermogenesis: the crouching tiger hidden dragon of societal weight gain. Journal of the American Heart Association, 26:729-736.  Retrieved from: on July 14, 2017

Wear Sunscreen. Seriously.

This week, we have a special guest blogger.  This is Matt’s brother, John.  He’s the one on the right.  He’s a Naval Academy graduate, MBA, rugby All-American Honorable Mention, fitness fanatic, outdoors fanatic.  My dad used to say that we were best friends starting the day he was born.  I can say that there were not a whole lot of times where we were not hanging out together.  We laugh at jokes that are never actually verbalized, we just know and start laughing without even a look toward each other.   The story below is an important one for every single person who goes outside.  It’s a tough post for me to read and I am sure it was very hard for him to write.  Please read and share as it is such an important message.

**Please be aware that some of the images may be considered graphic but we are using them to make you aware of the seriousness of this post.**

Wear sunscreen.  This was advice was given in an article by Mary Schmidt, a columnist for the Chicago Tribune, in 1997.  It was intended to be ironic because it was a mock commencement speech for college graduates and “advice is wasted on the youth.”  I read the article very soon after it was published.  I did not see the irony, I only saw humor.

In 1997 I was 28 years old and living in San Diego.  I was involved with every sport I could fit into a day; surfing, swimming, volleyball, running…anything.  This type of activity has continued throughout my life, albeit, not as frequently now.  I get to the pool 3-4 times a week and still manage to ski/bike/kayak when I can.  If I am outdoors, I am a happy person.

I have always worn sunscreen…well, about half the time.  But, I rarely got sunburned and, when I did, it was gone the next morning.  I was always aware of the sun and made sure I was acting responsibly.

I am conscious about what I eat.  According to my own grading scale, I would say I eat “better than most.”  Despite my daily chocolate fix, I keep red meat to a minimum, devour chicken in any form and eat plenty of fruits and vegetables.  I recently adopted egg whites with lots of veggies as my go-to breakfast.  No sodas.

So, by all accounts, I am a healthy person.

In February of this year I noticed a mole on my back that was raised and blue-ish.  I have had this mole for as long as I can remember but, previously, it was flush with the skin and a normal brown color.  I showed it to my wife and we both got on the phone immediately to find a dermatologist.  After several calls with potential appointments a month out, I was able to find one doctor willing to take me the next day.

The doctor agreed that the mole was suspicious and found two smaller moles a few centimeters away.  He recommended that each mole be removed and sent for biopsy.  But, given my skin tone and my general health, his exiting statement was “everything should be just fine.”

One week later I received a phone call while in my car.  The greeting was somber followed with the question, “Are you someplace safe where we can talk?  You may need to stop your car.”  Nothing good ever follows an introduction like that.

The biopsy results indicated that two of the three moles were malignant and the third was pre-cancerous.  Of the two malignant moles, one was diagnosed as “nodular” melanoma.  Nodular is a more aggressive form which penetrates INTO your body as well as superficially.  This meant immediate, aggressive intervention was needed.  If the cancer gets below the skin and into my lymph nodes, it could possibly reach my internal organs.

One week later I had surgery.  At 9am, in Nuclear Medicine Department, I was injected with a radio-active dye at the sight of my moles.  The dye will help identify the path cancer would take if it did work its way into my lymphatic system.  The radiologist marked my skin above the suspected lymph nodes.  He then passed the information onto the oncologic surgeon.  Thankfully the dye only drained to my axillary (arm pits) lymph nodes, both left and right.  It could just as easily drained to my groin area too or my neck, each requiring specific surgical attention.

I was wheeled into the operating room and the first incision started at approximately 2pm.  The entire procedure was completed after 8pm.  The
surgeon took a total of 7 lymph nodes from my armpits and then a large swath of skin from my back.  The depth of the back excision went down to the top layer (fascia) of my back muscle.  Now the wait begins…how far did the cancer penetrate?

The following five days were an experience I would not wish on my worst enemy.  It’s human nature to fill informational voids with something, anything.  By the minute, these voids changed from hopeful wishes to thoughts of helplessness.  What if it’s in my brain?  Liver?  Pancreas?  It can’t be in my brain, I’m a young healthy guy with a wife and little boy.  I’ll be back to normal next week.  How does chemo work?  I can’t pull off a bald-head…how fast do you lose your hair?  How will my son be affected by this?  Who will read my eulogy?

Worse yet, my family and friends aware of the situation also had similar thoughts.  Watching and hearing them suffer with the unknown was worse than dealing with my own mind games.  The results of the surgery could not come sooner!

The surgeon called four days after surgery.  Because it was so soon, I wasn’t expecting to hear the results.  I assumed he was calling to see how I was doing.  My wife could hear the doctor as he said all was clear.  They were able to remove the cancer before it spread.  The tears began immediately and, honestly, still come occasionally.

It has been a struggle getting back to my normal, physical routine.  The surgery was more invasive than I expected and took a lot of strength from me.  But, the physical recovery is the easy part.  Set a goal, create a plan, work the plan.  I can do that.

The psychological aspect has changed my life forever.  I often have thoughts of uncertainty.  Did they get all the cancer?  Is it working its way through my body?  What if…?  These thoughts are unnerving and consuming.  And, as if I didn’t need a reminder, I now see a dermatologist every three months.  I’m instructed to inspect my body daily for mole changes.  In addition to frequent sunscreen applications (even on cloudy days) I have adopted a new wardrobe.  I sport fully brimmed hats, long sleeve SPF shirts and light weight pants.  I hope this new look catches on…highly doubtful.

Make sure you put sunscreen on that has “Broad spectrum coverage.”  Without this, you are not getting protected from the sun’s harmful UVA rays.  If you are going outside to exercise, have fun, garden, hang out…whatever, put sunscreen on.  Reapply every 2 hours.  If you go into the water or sweat from exercise, reapply more often.  Wear sunglasses and a hat.

Mary Schmidt’s advice is not just for the youth.  It applies to all.  Wear sunscreen.  It is no joke.

Exercise? But I am going on Vacation!

Yes, you should even exercise on vacation. I always tell our patients that exercise should be looked at as mandatory, not optional.

Would you say you can’t sleep or eat on vacation? Probably not, right? So, why say you can’t exercise?

When you are on vacation, you may simply have to change the way your normally exercise. Nowadays, most, if not all, hotels have a gym on site and, guess what? We pay a hotel fee upon check in that is in part for this service. If we don’t use the gym, then we are paying for something we are not even using.

There are a few places that may not have a gym on site. This would be rental homes or time shares, possibly.

Well, have no fear! We have a workout you can do without a gym or dumbbells or expensive and large equipment. What most people don’t know is that we have the best piece of equipment ever that can be used pretty much anywhere: OUR BODIES!

Yes, you can obtain a wonderful workout with nothing except your body and maybe some exercise bands.

So even though you are on vacation, your heart, muscles, bones, blood flow, etc. are not! So, let’s exercise so that we don’t feel like, “oh I fell off the wagon and need to start all over” after a wonderful well deserved family or solo vacation!

Below you will find a full body exercise program you can follow while on vacation and it can be accomplished in under 15-30 minutes! Before you begin, decide if you would like to do each exercise by time or by repetitions. If you choose time, set a time for 1 minute each exercise, if you choose reps. Do 15 reps switch to next exercise. When you finish 1 round of each then you can repeat 2-3 times.










Ceiling reaches (core)

Hip abduction (hip muscles)

Bicep Curl


Bridge (core and gluts)








Shoulder flexion






Side Plank  (30 seconds each side) Regular plank (hold 30-60 sec.)











front view







Scapular squeezes (shoulder blades)








toe raises

There you have it! A solid full body strengthening exercise program that you can do even on vacation. There are a total of 9 exercises so lets say you plan to do each exercise for 1 minute, you will be finished in less than 10 minutes and if you repeat each 2-3 times you will have completed a full body exercise in less than 30 minutes. You will have plenty of time to get back to that fun vacation and relaxation with the ease of mind knowing that you did a great work out.

I know exercise is the last thing you want to do while on vacation, however it is important to stay on track at all times because getting back on track can be a challenge. Falling off the wagon is not only difficult physically but emotionally it can take a toll.

Starting the exercise is the most difficult thing to do, but once you start that is it!  It also feels so amazing when you are finished. Its a sense of accomplishment.

So, before vacation, just like you buy a new swim suit for the beach or travel kits for personal hygiene, don’t forget to purchase some affordable and perfectly pack-able exercise tubes/bands.

I’d love to hear how your vacation workout worked for you, so please leave me a comment or any questions. Enjoy your Vaca!!



On your marks, get set, GOALS!

This week, we would like to talk about goal setting.  Goal setting is an important part of just about everything you do: finances, family, career, etc.  This post will focus more on fitness goals but you can apply this to anything in life.

What is really important to understand is that saying, “This is my goal” but then not have any plan set to achieve that goal is not helpful.  I read a quote quite some time ago that I thought put this into such great perspective:

A goal without a plan is just a wish

I am not sure if there is an original author of that but it has stuck with me.  I use it to help patients, clients, my family…anyone who is trying to figure out how to reach their goals.

Let’s start with motivation.  People can set all the goals they want, but without knowing what it is that is driving them to achieve these goals it is destined to fail.  If you have a goal, let’s say run a marathon.  The first question you want to ask yourself is, “Why do I want to do this?”  When I started swimming as my primary fitness exercise, my motivation was my health.  My dad had passed away from congestive heart failure a few years prior.  With a simple look in the mirror, I knew I was heading in the same direction.  Lucrecia loves dancing and needed to find a way to keep dancing after an injury.  So, she and her husband choreographed some Latin-style dance routines to several songs and she uses that to keep herself and our patients moving while having fun!  It is one of the classes that the patients here just love!

So, why do you want to do the marathon?  It can be something like, “I love running but I need to have something to strive for.”  Or it could be that you really like a girl/guy who runs a lot and you want to have an activity you can do together.  The first example is considered an intrinsic motivator while the second is extrinsic.  Maybe both are striving for that medal at the end of the marathon that says, “I did it!”  That, too, is an extrinsic motivator.  The point is, ask yourself why you want it then use this motivation to push through the hard days.

Now, let’s talk about your goals.  We can build on the marathon goal.  To say you want to run a marathon is a great start., but not enough.  Your goals should be:

  • Specific
  • Challenging
  • Realistic
  • Quantifiable

Two things to tack on are: KISS (Keep It Simple Stupid) and Set Dates!  Do not have goal that gets too elaborate.  Specific yes, elaborate no.  Marathon = Simple…in the strict sense of it being the goal.  It is definitely not a simple task!  This marathon is now your long-term goal.  And this is where you start with your actual goal setting.  You know you want to run the marathon and what is motivating you to do it.  Now, how do you reach that goal?  How do you keep yourself from burning out or saying, “This is stupid,” ”I will never get there,” “This is too hard,” etc.?

Let’s look at each of the four goal setting rules above.


I have already touched on this but I will explain further.  To say, “I want to run for fitness” is a good goal but not a specific goal.  To say, “I want to lose weight” is a good goal but not a specific goal.

To be specific on the running, we have set a marathon goal.  You need to be able run 26.2 miles consecutively to complete a marathon.  That’s pretty specific.  But what about losing weight?  When I have clients who want to lose weight, I ask them to stop stepping on the scale and start watching what happens to their clothes or how well they are sleeping or how much energy they have during the day.  However, if weight loss is your goal, how much weight do you want to lose?  What is your ideal weight?  Exact number.  That is how you set a specific, long-term goal.


The goal you set should not be something you can already do.  The goal should be something you have to work for.  This will help you feel accomplished and want to set new goals once you reach this one!

Take the marathon example.  What if you can already run a marathon?  Does this mean this goal is not good?  No, it does not.  How about you set a goal of completing the marathon in a certain time?  Or run a very specific marathon that requires an invite or proven times?

For the weight loss example, do not set a goal of losing 5 lbs. in 6 months.  That would not be challenging you.  2-3 pounds per week is ideal and the safest.  Thinking in these terms, set your goal.


Going to the other end of challenging, do not set goals that will be too difficult to reach.  If you have never run more than a 5K and you set a goal to run a marathon within 1-2 months, that’s very unrealistic and this can cause you to feel as if you have failed.  To set a goal to lose 50 pounds in 1-2 months is, again, unrealistic.


This means you want to be able to measure your progress.  The marathon has a specific distance you will need to cover, so you can measure how close you are getting with your training runs.  You can use times to find out how well you are doing in terms of minutes per mile.

For weight loss, having a specific number in mind will allow you to track how close you are getting.  Or, you can set a goal to reach a specific dress or pant size.  Or even a specific number of inches off your waistline.

There are many ways to make this measurable.  Set your long-term goal in such a way that you are able to measure your progress.

Feeding off of those rules are “KISS” and “Set Dates.”  Don’t think too much about your goal.  When I started swimming for fitness, I needed something to strive for.  Striving for fitness is great but it is not really measurable and not all that simple.  I decided to swim the Alcatraz Invitational.  This is a 1.25 mile swim from Alcatraz to Aquatic Park in San Francisco.  It was a very specific goal that was not hard to identify what I needed to do to complete the swim.  Even better, it had a specific date set.  I did not have the opportunity to say, “If I don’t reach the goal by this date, I’ll just do it later.”  No, the swim was on that specific date, far enough out that I could build up my abilities to accomplish the swim.  Setting dates keeps you accountable and gives you a plan.

Ok, great.  I have a specific goal that is challenging, realistic and quantifiable.  I’m all set, right?  Well, not yet.  Let’s break it down further.  You have taken those first steps:

  1. You know what you want to do
  2. You know what your motivation is to complete it
  3. And you have set a specific goal to get you there

Now, from that specific goal, called your long-term goal, you can set a mid-term goal and milestone goals.  So, you have set your long-term goal with a specific date and now you need to find where the mid-term of this stretch is.  If the long-term goal is 6 months out, then the mid-term will be at 3 months.  Give yourself a reward at the mid-term: new running clothes, new shoes, etc.  This goal has to follow the same rules as the long-term goal: specific, challenging, realistic, and quantifiable.

From here, set milestones.  These should have dates close enough that you are reaching milestones often enough to see progress is happening but far enough that there is progress.  Two to four weeks is usually pretty good for these.  You can reward yourself for each milestone as well, but it should be something smaller.  As you reach each milestone, remember to look back at where you were and how far you have come rather than forward at how much you still have to do.

One thing I like to tell clients and patients is to put each goal on a sticky note and put them along the top of the bathroom mirror.  The long-term goal at the end on the right, mid-term in the middle and milestones where they belong filling in.  As each milestone and goal is achieved, take that sticky off.  This will let you see that progress is being made.

Lastly, do not get discouraged if a milestone is not reached on the specific date.  Things come up in life that will cause a bump.  You may need to work a little harder to get back on track but you will make it.  Keep going forward!

We hope this helped everyone set goals!  If you have any questions or would like some advice on specific goals, please feel free to comment below.


I have yet to meet a person without some sort of “issue.”  Everyone has something that may be considered abnormal.  There are things that cause some people anxiety that do not bother most others.  Crowds, tight spaces, spiders, flying, or water are all examples of this.  But to just look at these people, you would most likely never know.  However, when someone has a physical “issue,” most of the time, you can see it right when you meet them.

I was watching a show last week about a couple who are little people.  They have kids, one of whom is also a little person.  He is married to a woman of regular height and they are about to have a child of their own.  They just discovered that their child will also be a little person.  As the young man spoke to his dad about this, he mentioned having to teach his new son about the trials of being a little person.  His dad’s response was along the lines of physical issues the child may have to endure.  But this is not what the new dad meant.  He began talking about the psychological and emotional issues that get hidden deep inside.  For him, it was not being able to keep up with his brothers when playing soccer or not being able to climb a tree as fast as his brothers or friends.  While he was able to play soccer and was able to climb trees, others were much faster and it bothered him knowing that he would never be able to keep up.

I was born with one hand.  My dad tried very hard to make me feel like everyone else.  I tell people who ask if I miss having a hand, “I never had a hand so this is what is normal to me.  I cannot miss something I never had.”  To me, it was never if I could or could not do something, it was always trying to prove to everyone else that I could.  I remember my first flag football team.  The coach saw me walk up and immediately put me on the line.  Remember, my dad tried to make me feel like everyone else.  That means when we went out to play football or baseball or whatever, he treated me just like my brothers.  I learned to catch the football and was pretty damn good at it.  So, this coach sees me and never even gives me a chance to show him that I can play other positions.  Everyone else got that chance, I was just automatically pigeon-holed, “He has one hand, he can’t catch.”  This was my first experience with that kind of thing but it definitely was not my last and I am sure I will continue to experience this for the rest of my life.

I went on to play 17 years of rugby.  If you know rugby, you know that everyone catches and carries the ball in just about every game.  My position was one that had me handling the ball more than some but still less than others.  I have discovered that there is a way for me to do just about anything anyone else can.  Some things take a little ingenuity to make it work but my thinking is, “I will find a way.”

The point of all of this is to bring to light that people with physical disabilities usually do not consider themselves as disabled.  It is to let those without physical issues understand that those with them are struggling with the reality that they do not have the same thing most others do but they still can do the same things.  It is to let those with these issues know you can do that!

There is a way to lift weights.  There is a way to play sports.  There is a way!  I would love for this post to be specific to each physical issue and help each person in one post, but it’s not possible.  However, teachers, trainers, coaches, parents, and friends can all help dispel the myth that someone with a disability cannot do the same things.

My college rugby coach never saw me as a player with one hand.  He saw me
as a player.  Just as he saw the guy who struggled with grades as a player.  Or the guy who was claustrophobic as a player.  Or the really small kid as a player.  He treated me like any other player on the team and discovered that the position I played in high school was not a great fit and moved me into a new position that allowed me to use my speed a little bit more.

This is what everyone can do for everyone!  Do not treat a person with something you can see any differently than the person with something you cannot see.  If one-handed guy wants to learn to play football, teach him.  If she wants to learn baseball, teach her.  If the guy who has never skated wants to play hockey, teach him.  If the short girl wants to play basketball, teach her.  Help them gain the skills needed to play or do what they want to do.  There will come a point where each person will decide they can or cannot do something.  It is not up to anyone else to make that determination.

Each person who has a physical issue knows that you can see it and believes that you are making some sort of judgement on it.  This is not because they are paranoid, it’s because of experience.  They already know that they cannot climb a tree as fast as others.  They already know that to learn to catch a football it’s going to take a little more time.  What they want is to believe that you believe in them.

To those with a physical issue: where there is a will there is a way.  Don’t worry about “keeping up.”  Worry about being better!   ¡Si, se puede!

Low Back Pain?

Help!  My low back hurts!

Working where we do, low back pain is extremely common.  I have friends and family ask me what they can do to help with their low back pain.  I have met many people at gatherings who, after finding out what I do, ask what they can do about their pain.

The first thing you need to do when it comes to low back pain is pay attention to the symptoms.  Is it an achy pain localized to your low back?  Or does the pain radiate down to your backside or down your legs?  Does it radiate around the front into your hip flexors or quads?  Is there weakness, tingling or numbness in your lower extremities?  What aggravates the pain?

There are so many questions that need to be answered but I will try to keep things a bit more general.  It is a good idea to see a doctor if you have long term low back pain that does not seem to be getting any better.  If there is a pars defect (spondylolisthesis or spondylosis), it is important to avoid extension type exercises.  However, this does not mean you cannot exercise.  Having an idea of what is or may be the cause of the pain will go a long way in deciding what types of exercises to do…or avoid if necessary.

Having your flexibility checked will tell us quite a bit.  Too many times a person tells me that his hamstrings are “really tight” as he bends forward and easily puts his palms on the floor!  There are two proprioceptors in the muscle that can affect how your muscles feel.  The muscle spindle and the Golgi tendon organ (GTO).  The muscle spindle helps to keep muscles from over stretching and the GTO helps to relax the muscle.

When you begin to perform a stretch, your muscle spindle activates to help protect the muscle from injury.  With a gentle, static hold, after approximately 20 seconds, the GTO will kick in and allow the muscle to relax and stretch.  So, when you hold a stretch for 30 seconds, you are actually only getting about a 10-second stretch on that muscle.  Performing this stretch a second and third time, you will notice it does not have that tight feeling you had during the first stretch.

Now, if you are in a stretched position for a long period of time, the muscle spindle will say, “Hey!  Wait a second.  This is too long.”  It will kick in slowly to protect the muscle again.  Think about a long car ride.  You are driving and 2 hours into the drive, you feel achy between your shoulder blades and maybe your low back.  You pull off at a rest stop and get out.  The first thing you do is to bend forward and reach your hands to the ground.  What you are doing is putting yourself into nearly the same position you were just in.  Your low back was in a stretched position and your shoulders were protracted while holding the steering wheel.

To counteract the effects of the muscle spindle engaging, you will want to activate those muscles.  Going back to the person who says their hamstrings are tight but can put his palms on the floor, a good exercise would be something that activates the hamstrings.  I would even take this a step further and activate the low back core muscles.  Bridges or planks would be good exercises to help engage these muscles.  For the driver with pain between his shoulder blades, some shoulder flares or row-like activities would help to activate the middle traps and rhomboids.

This is not to say that anyone should stop stretching.  Flexibility is just as important in low back health.  However, if you feel that tight feeling, remember that it could be from stretching too much.  A solid balance between flexibility, stability and strength will help you maintain a healthy back and help you reduce the incidences of back pain and decrease the duration should it occur.

Now, let’s go through a good routine to help your back.

We will focus on the core.  This is key to good back health.  The core is not just your abdominal muscles.  It involves your pelvic muscles, lumbar muscles, and abdominal muscles as well as support from muscles below and above these areas.  So, doing abdominal work every day but ignoring muscles around your pelvis and lumbar regions are only doing part of what needs to be done.

Core strengthening


If you do not have a pars defect, bridges are very beneficial and will work your whole core.  With a pars defect, you will need to talk to your healthcare provider about performing this exercise.  This exercise will activate core musculature as well as lower extremity muscles.

  • Lay on your back with your knees up, feel flat and toes pointed straight forward.
  • Raise your hips toward the ceiling as high as you feel comfortable and hold this position 5-10 seconds.
  • Lower slowly back to the floor or mat.
  • 3-5 sets of 10-20 of these each day will help with stability of your core.


This is an excellent total core exercise.  If you have a pars defect, again, see your healthcare provider about this exercise.  However, this is an exercise that is very modifiable to each person’s ability.  This, too, will activate lower extremity muscles as well as core musculature.  They can be done with fully extended arms, on your elbows, knees rather than full plank, arms raised on a chair, bench or the wall, various versions of side planks, etc.

  • With this exercise, you get into position face down with your hands or elbows directly below your shoulders.
  • Raise your hips toward the ceiling until your spine is in a neutral position head to tailbone and in line with your lower extremity.
  • Squeeze those cheeks! As one instructor once said, “Wink at the ceiling!”
  • Hold this position for the desired time (10 seconds, 15 seconds, 30 seconds, 1 minute, etc.)
  • Rest and repeat.

You can set a goal for this to be able to perform 3 planks of 1 minute each.  If you start with a modified version, you can progress until you are performing a fully extended plank for 1 minute each.  Beyond this, there are variations you can do to increase the challenge.

Ceiling reaches:

This exercise focuses on your abdominal muscles.  It is important to attempt to maintain a neutral spine during this exercise.

  • Lay flat on your back, knees up, feet flat and toes pointed straight forward.
  • Raise your arms directly in front of your chest and pick a spot on the ceiling directly above your hands.
  • Reach up toward that spot until your shoulder blades leave the floor or mat.
  • Focus on trying to have this movement occur at the hips.
  • Do not “throw” yourself toward the ceiling. Rather, gently raise yourself up and down.  Do not drop back to the mat.  Stay in control the entire time.
  • 3-5 sets of 10-20 each day is a good goal.

Neutral Spine Abdominals:

If you are not able to perform ceiling reaches due to pain or weakness, this exercise is a great starting point.  This will exercise your abdominal muscles while you maintain a neutral spine position.

  • Lay on your back with one leg extended straight and one knee up with the foot flat.
  • Place one hand just under your low back on the side in which your knee is up. Do not force your hand under your back, just slide it until it is in support of your back.
  • Raise your head off the mat as if you are attempting to push your chin straight up to the ceiling.
  • Lower back to the floor or mat in control.
  • 3-5 sets of 10-20 reps each day is the goal progressing to the ability to perform the ceiling reach exercise.


This is an exercise anyone with a pars defect should not do.  The purpose of this exercise is to extend your back and focus the attention on the lumbar muscles.

  • Lay face down on the floor or mat.
  • For Superman, your hands are straight above your head. For Rocketman, your hands are at your sides.  Palm down in each.
  • Raise your head and chest off the floor/mat. Superman: arms move up and squeeze your shoulder blades while your palms stay facing down. Rocketman: as you raise, your thumbs rotate toward the ceiling and squeeze your shoulder blades.
  • Hold this position 5-10 seconds and return to starting position in control.
  • 3-5 sets of 10-20 each is the goal.

Hip Flexor:

This exercise is for the iliopsoas muscles in particular but may activate quad muscles as well.  This will help to strengthen and stabilize the hip and pelvis.  There are variations on this but here is one simple way to go about this exercise.  It can be performed seated or standing.  Here, we are in the standing position.

  • Using an ankle weight and standing in front of a mirror, you will march in control.
  • Your knee should reach parallel to your hip.
  • Each raise and lower should be in control with your knee tracking in a straight line and holding good balance with the other leg.
  • By alternating legs each time, you are forcing your body’s proprioceptive skills to learn as well.
  • 3-5 sets of 10-20 steps is a good goal before increasing the weight or moving to a more challenging exercise.

Hip extension:

This is another exercise designed to strengthen and stabilize the hip and pelvis region.  This, combined with the hip abduction exercise below, will work your gluteal muscles.  This can be done with bands or ankle weights.

  • Standing and using a chair or wall as a balance check, have the band or weight on your ankle.
  • With your whole leg straight, push your ankle straight back, tightening the glute muscle on that side. Your knee should not bend at all and your foot should remain pointing forward throughout this exercise.
  • Return your foot to the starting position in control.
  • 3-5 sets of 10-20 reps each leg.

Hip abduction:

This is the second exercise designed to strengthen your glutes and help to strengthen and stabilize your pelvis.  You can move directly from the hip extension into this or do a circuit utilizing both exercise in succession.

  • Standing and using a chair or wall as a balance check, have the band or weight on your ankle.
  • With your whole leg straight, push your ankle straight to the side to about 45 degrees. Your toes should point straight forward during this movement.
  • Return your foot to the starting position in control.
  • 3-5 sets of 10-20 reps each leg.


As mentioned, a good balance between activation and stretching muscles is what will be most beneficial to good back health.  The following are stretches to help keep your muscles flexible and moving efficiently.

Hamstring stretch:

There are many ways to accomplish this, but the most simple is described here.

  • Lying on your back use a stretch strap to pull one leg up at a time keeping your knee straight. Your opposite leg should be bent to help relax lumbar muscles.
  • Another option is trying it in a seated position
  • Make sure you keep your spine straight and
  • Hold either position 30-60 seconds.
  • Slowly return to standing.
  • 3 sets

Hip flexor/Quad stretch:

  • Lay on your back near the edge of a low table or bed.
  • Hang one leg off the side with the other leg on the bed knee up and foot flat.
  • Bring the foot of the leg off the bed back as if trying to reach it to your backside but rest your toes on the floor.
  • You should feel a stretch at the crease of your hip and/or down the front of your leg.
  • Hold 30-60 seconds.
  • Slowly return to starting position.
  • 3 sets each leg.

Single knee to chest:

  • Lay on your back knees up and feet flat
  • Bring one knee to toward your chest and, using your hands or arms, squeeze your knee to your chest.
  • You should feel a stretch in your glutes and/or low back.
  • Hold 30-60 seconds.
  • Return to start position and perform on other leg.
  • 3 sets.

Figure 4:

  • Lay flat on your back, legs straight.
  • Place one foot across the knee of the other leg.
  • Slowly raise the knee of the opposite leg by dragging your heel along the floor/mat.
  • Raise until you feel a comfortable stretch deep in your backside of the crossed leg.
  • Hold 30-60 seconds.
  • Slowly return to starting position and perform on the other side.
  • 3 sets each.

Cobra stretch:

This is not a stretch to be performed by someone with a pars defect.

  • Lay face down hands in push up position.
  • Push your chest up and move your head back until you feel a comfortable stretch in your abdominal muscles.
  • Hold 30-60 seconds.
  • Slowly return to starting position.
  • 3 sets.

Supine spinal twist:

  • Lay on back with knees up and feet flat.
  • Extend arms straight out to sides (forming a “T”).
  • Allow both knees to fall, in control, to one side as far as comfortable.
  • Turn head the opposite way.
  • Hold position 30-60 seconds and slowly move to the opposite side.
  • 3 sets each side.


This may seem like a lot of work.  You can pick and choose which of these you would like to do each day.  Do try and perform some sort of core exercise and stretch routine each day to help maintain good back health.

If you have any questions on how to progress or modify any of the exercises, please ask below in the comments sections.  If you are concerned about exercising with an injury you have or had, we are happy to help.  If we cannot answer outright, we have a clinic filled with providers who are willing to let us pick their brains.

Next week, we will discuss disabilities.  It will focus on those born with disabilities and the physical, mental and emotional challenges faced.