Using Exercise to Prevent Injury

This article was first published in The Hindu in May 2017.

Have you ever bent down to pick up something and had this terrible spasm in the back, knowing immediately that you’re in for several days of ‘rest and physiotherapy’? We often perform daily activities incorrectly, either because we have no idea just how to do them right, or because we are unable to do them right due to weakness or an imbalance.

Muscles exist as pairs in our body, one on either side. For instance, a pair of quadriceps in the front of the thighs that extends the knee joint. They also have opposing or antagonistic muscles that perform the opposing action. So for example, the quads, as fitness people like to call them, have the hamstrings, at the back of the thigh, that flex the knee joint. These muscles must act in synchrony for us to be able to walk, run, squat, climb and sit. If there is an imbalance between these muscles (as there often is), the result is awkward and difficult execution of movements and a resulting injury or pain.

For a pain-free, active life, we must strengthen muscles throughout the body. Without this, muscles often deteriorate and atrophy (become less) with disuse. Here are three common moves we all perform in our day-to-day life, and how to optimise them, for easy, graceful mobility.

Bending to pick up something heavy

The right way: Get close to the object (or the child), squat (bend knees), bring the weight close to the body and stand up, holding the weight as close to the body as possible. 

Develop the muscles: Do the bent-knee dead lift. Stand behind the barbell (or a heavy balanced pole—for non-gym people), feet hip-width apart. Hinge at the hip by pushing the hips back as you bend forward. As you lower further, start to bend at the knees until you are able to reach and grasp the barbell in the centre. Inhale as you lower. At the lowest point of your forward bend, you should feel the stretch in your hamstrings. Depending on the flexibility of the hamstrings, some people may be able to lower the upper body quite far without having to bend the knees, while others may need to bend the knees at an earlier point. As you exhale, pick up the weight; straighten the torso by fully extending the hip and knee joint. The barbell remains close to the thighs. In the final position, stand up straight, shoulders back and engaged, while carrying the barbell. Lower again by keeping the barbell as close to the body as possible. Don’t allow the weight to touch the ground. Lift again and repeat for 8-12 times. Rest for 30 seconds and do another 3-5 sets.

Reaching up to bring something down from a shelf

The right way: Stand directly beneath and slightly away from the shelf above. Reach up, grasp the object, so the weight is evenly balanced in your hands. Lower without arching the back or leaning backwards. 

Develop the muscles: To develop core, shoulder and arm strength, the plank and shoulder press work well. For the plank, support yourself, face-down on your forearms and toes on a yoga mat. Keep the back flat, abdominals engaged, neck aligned with the spine, so you are not looking too far up or down. Breathe normally. Hold this position by keeping the core engaged for as long as possible. Work up from a 30-second hold to about 90 seconds. The core includes muscles of the abdomen, back, pelvic floor, deep hip and shoulder muscles.

You can do the shoulder press sitting, with your back straight or standing with feet hip-width apart. Hold a pair of dumb-bells in both hands, with palms facing forward, upper arms at the level of the shoulders, and elbows bent at right angles. Lift the weights by straightening the elbows, and push them straight overhead, so arms are parallel, almost touching the ears on the sides. Reverse the movement by bending the elbows and bringing the dumb-bells back to shoulder level. The movement needs to be performed slowly. Perform 3 sets of 10-12 repetitions at each routine. Use a weight that is heavy enough for you to complete just 10-12 repetitions.

Pushing a heavy piece of furniture

The right way: Place yourself directly behind the weight, in a staggered stance (one foot in front of the other), engage the core (tighten stomach muscles), bend forward slightly at the hip joint, place both palms on the side of the furniture, and push with the back flat, engaging mainly the chest and shoulder muscles. 

Develop the muscles: Practise the push-up and plank, to strengthen chest muscles, the shoulders and the back of the arms or triceps. For the push-up, go down on your hands and knees. The palms are placed flat on the mat beneath your shoulders, but wider. The knees are placed directly under your hips on the mat (beginner), or slightly behind the hips (intermediate) or you could go up on your toes (advanced).

Breathe in and lower the upper body towards the mat, by bending the elbows. Lower the chest till it almost touches the floor between your two palms. Exhale as you lift to starting position. Repeat 10-20 times.If you feel you can’t get down on the floor just yet, start with the chest press exercise, which uses dumb-bells to build up strength in the very same muscles, then progress to push-ups.

Is Your Trainer Fit for You?

This article was first published in The Rotary News in Aug 2018.

When you start on your fitness journey, or even if you are already immersed in it, you may want to hire a personal trainer to coach and guide you. Many people need that extra motivation they hope their trainer will provide. So how do you go about engaging the right trainer and how do you decide if he is the right fit for you?

There are several bodies that certify trainers. It could be the IFAA-India (International Fitness and Aerobic Academy); ACE (American College of Exercise); ACSM (American College of Sports Medicine); or the National Academy of Sports Medicine and several more. Your trainer may be a physiotherapist by qualification who is specialised in a particular field such as strength training or pilates. Many trainers who are perhaps athletes or sports persons, or have been body builders, are absorbed by a fitness facility and trained there to work with their clients. Check into their background when you start to work with a trainer.

Although your trainer’s skill and knowledge are important, what is even more important is his or her interpersonal skill, emotional and social intelligence and ability to guide and motivate. He or she may be very qualified and knowledgeable but lack in empathy and understanding of the clients’ needs.

What is your trainer’s fitness philosophy?

It is worthwhile to ask your trainer what his idea of fitness is. Is it just about looking buff or lean, or is it more holistic, combining nutrition, motivation and overall wellbeing? Does he understand his clients’ needs or works solely from his own perspective? Does he believe in helping others achieve their goals?

Here are some questions to address

• Does he understand the various aspects of fitness such as aerobics, strength, flexibility etc, and how  these should be applied to you?
• Does he understand the importance of diet and can he advice the right diet for you or refer you to a nutritionist? Does he talk to you about your dietary habits?
• Does he know enough to handle your health condition? Say, you are diabetic and on medication, does he know enough to manage you while exercising? Does he ask about the medication you are taking? Or, if you are a senior person, can he handle an older client? Has he worked with older clients before?
• Does he ask you detailed questions to understand your lifestyle? For example if your job is sedentary, if you travel a lot, if you socialise a lot, where you eat, if you have trained before, what kind of exercise you enjoy the most and so on.
• Does he give you motivating tips to fill in the rest of your day (not just the hour in the gym)?
• How does he motivate and challenge you? Does he use negative associations (by saying — you are fat and need to lose weight) or is he positive in his approach (by saying something like losing weight will help you lead a healthier, more enjoyable life and praising you when you improve)?
• Does he know just how much to push and challenge you or does he absolutely insist on pushing you beyond your capabilities to a point of exhaustion and injury?
• Does he constantly compare you with other clients?
• Are you motivated and inspired by him?
• Does he use encouraging language and praise you often when you achieve small goals or does he make you feel you are just not good enough?
• Does he help you set realistic goals and achieve them?
• Does he teach you your exercises, explaining them to you, helping you understand why you do them and what body part they address etc?

Every individual is different and needs to be treated as such. The goals you set for yourself should be your goals and not your trainer’s. Your trainer should be a person who can guide you towards your specific goals. He should also educate you about your fitness routine. The objective should be to exercise independently when necessary and not be dependent on a trainer telling you exactly what to do and how to do it for the rest of your life. It’s okay to want to be motivated or inspired, but at some point the motivation should come from within you.

Finally, a trainer who wants you to be dependent on him is not really working with your best interests in mind. If you have a great trainer, you should eventually be able to exercise on your own, know enough about it and understand why you are doing what you are doing. You should be confident enough to be able to handle your own fitness routine and perhaps even inspire others. 

Mind Your Body

This article was first published in The Hindu on August 06, 2018.

How I discovered the joys of exercise and self-awareness.

Way back in 1994, when I came back to Ooty from Chennai, after my post-graduation to join my mother’s obstetric practice, I didn’t quite realise what I had bargained for. In those days, Ooty was a small town with almost nothing going on. My life revolved around work. The isolation, frenzied work schedule, with a complete lack of friends, stimulus, entertainment or creative outlet, was nearly unbearable. I needed a coping strategy. For me, that came in the form of exercise.

I had always loved fitness even as a child, but now I was using it almost as a refuge. My long morning walks, aerobics in front of the TV (those days there was an Australian show on), and yoga, were not just about staying fit or losing weight. The endorphins kept my moods from plummeting.

From there was born my renewed respect for what exercise could do for me, not just physically but emotionally. Looking back, I may have been using exercise almost like a drug, to survive. Did I go into over-training? Perhaps at times I did, those initial few years. Today, I am wiser for it. I am very mindful of just how I use it, very aware that everything, however good, can be detrimental, if over-indulged.

Soon I started to recognise that my patients could also benefit from exercise. Many of their problems resulted from a lack of fitness or strength, being overweight or too frail. This was the beginning of my foray into fitness, as an extension of my medical practice.

How do I teach women to include fitness in their lives? How do I help them enjoy exercise? I certified to be a Fitness & Lifestyle Consultant from the National Association for Fitness Certification (NAFC) in the US in 2000, and started teaching exercise to women in Ooty.

My first and second books, Get Size Wise and Gain to Lose, were products of my experiences, and talk of the basics of exercise with plenty of real-life stories that I had encountered with women every day in the context of them trying to lose weight or get fit.

By the time I was ready to write my third book, Fit After 40, I had taken an extended course in positive psychology. I am very mindful of the fact that ‘fitness’ and ‘wellness’ never deal with only the physical self. The mind and body are so intricately connected that one can never truly be ‘fit’ without addressing our inner well-being.

Positive psychology is a fascinating field. I’ve always been interested in the workings of the human mind. In fact, my first choice for post-graduation was Psychiatry. Eventually, however, I changed my mind and chose ObGyn as it was a much ‘cheerier’ field with new beginnings and mostly happy endings. Psychiatry seemed rather gloomy and depressing.

Positive psychology deals with flourishing. How does someone who is doing okay, do even better? How do you thrive instead of just survive? This interested me greatly. Why do some people flourish while others languish? Positive psychology gave me an insight into all the above questions and a way to approach growing older, in my book. It also helped me personally, more than I can express. I realised, it all starts with self-awareness.

Self-awareness is not only knowing your preferences, weaknesses, strengths or even understanding your inner world, though of course, that’s a large part of it. It also deals with recognising just how we monitor and negotiate our inner world, and what we notice or understand regarding ourselves. So for instance, do we often admonish ourselves with ‘I should/shouldn’t have done that’? What is that self-talk that goes on 24/7 inside our heads? What are our preconceptions, biases and conditioning, and where do they come from? Identifying all this in a non-judgemental manner is the path to self-awareness. The key word is non-judgemental.

My own self-narrative had a lot of editing to be done! I learned that I was far too self-critical. While it may have helped drive me to work harder or be better, it couldn’t have been too good for me. We are taught to be compassionate towards our patients; self-compassion, however, is not always easy. I had to learn to take a step back to a better vantage point and just observe instead of jumping in with my own disapproval and/or guilt. I had to ask myself some very hard questions, and sometimes I didn’t like the answers! I’ve learnt that it’s okay to be vulnerable sometimes, to refuse sometimes, or to agree to disagree (without feeling guilty about it!). Being self-aware relieves you of the burden of trying to explain yourself, to fit in, or for that matter, to stand out!

The most important and longest relationship we will ever have is with ourselves. Writing the book helped me explore some fascinating aspects of my own self. It’s a journey well worth spending time on and being truly mindful of.

Fit after Forty is out on Amazon! Do take a look and order your copy now!

How to Begin Strength Training

This article was first published in The Hindu on March 12, 2018.

Myths debunked, questions answered and doubts cleared, here

Strength, like stamina and flexibility, is one of the primary pillars of fitness. It helps retain and build muscle mass, increase strength and even aid fat loss.

Know the means

There are two ways of increasing strength and muscle mass. You could perform exercises using your own body weight (pushups, squats, lunges), or you could use external weights like dumbbells, barbells or machines. I recommend that a beginner start with using lightweights with dumbbells or machines, and gradually build strength in order to be able to handle their own body weight. Once you build enough strength by using external weights, you could move on to using your own body weight to challenge your muscles further, and proceed to do a combination of own-body-weight exercises and those with external weights. All the exercises need to be learnt from a professional so that risk of injury is minimised. Before starting a strength-training programme, do get a clearance from your physician.

Begin right

A couple of pairs of dumbbells (about 2-4 kg each), a mat, weight training gloves, water and proper (fitted) attire is all that is required. How much weight you lift for each exercise will vary. Typically, the larger muscles of the body like the chest, back, shoulders and glutes will be able to lift a heavier weight than the smaller peripheral muscles like the arms and calves.

Know the terminology

A routine typically consists of a series of exercises addressing different muscles or groups of muscles.

Each exercise is repeated several times (repetitions or reps) until the muscle tires. After a short period of rest, the next set is attempted and the exercise is repeated again until the muscle tires once more. Ideally, for muscle growth, you should not be able to perform more than 6-10 repetitions of the given exercise in one set. This means that after about eight reps, your muscle begins to protest, and by rep 10, it is so fatigued that you cannot push for more reps. Only you can decide what weight to use for each exercise. The weight you use will also differ from exercise to exercise. In time, you need to be able to push yourself gradually to increase the weight you use for each.

Performing each exercise with perfect ‘form’ is important if you want to prevent injury. Each exercise has dos and don’ts. These need to be adhered to meticulously. Understanding and remembering all the instructions for each and every exercise, (such as breathe in as you lower, breathe out as you lift, keep the back flat, keep the core engaged, keep the head lifted, spine aligned and so on), takes time and effort. While the exercise may appear simple, many get injured, especially as weight increases. This is one of the reasons why it is always preferable to have a trainer guide you to correct mistakes during the first few months of your initiation into weight training. Make sure the same muscle is not worked within 48 hours. So for instance, if you perform all the upper body exercises on a Monday, you should rest those body parts and aim to work them again only on a Thursday. You could then perform all the lower body exercises on a Tuesday and a Friday.

Fitness Buddies

A Change In Attitude

So you want to lose weight. Half the world does. Obesity is a worldwide epidemic so it’s only natural that every second person you meet is keenly seeking the holy grail of weight loss. Dinner conversations invariably return to feelings of guilt over indulgences. The Internet is flooded with clever advertising to lure vulnerable individuals into buying some product or the other with the promise of ‘losing ten kilos in ten days’ or similar fantastic claims.
You may not be thrilled with your body right now, in fact, you may view it with a good deal of distaste. Let’s ask ourselves a question, how did we get this way? How did we pile on the pounds? Where is that slender teenager? No doubt there are some who struggle with obesity all their lives. Over weight as children and teenagers, they are often faced with ridicule and marginalized. A large percentage of the population however, grows obese with age. A certain amount of weight gain with age is acceptable. But to become obese and as a result develop various obesity related complications like pain and discomfort, diabetes, heart disease, anxiety, depression, indigestion and so on, is not.
Take stock of your lifestyle.
– Are you physically active all day or does your job entail a lot of sitting behind a desk?
– Do you exercise regularly?
– Do you stay home and watch a lot of television and do little physical labor?
– Do you deal with an inordinate amount of stress? More importantly, are you one of those people who does not handle stress well? Do you develop acidity, anxiety or insomnia as a result of your stress? Do your work and relationships suffer? Do you become an insufferable boss or mother?
– Do you go on eating or drinking binges?
– Do you starve yourself often with the hope of losing weight only to go back to binge eating?
– Do you get enough sleep? (Six to eight hours a night of uninterrupted sleep is recommended.)
– Do you eat well-balanced meals with plenty of vegetables, fruit nuts, protein and healthy fats or are you loading up on the bread/cereal group (rice, rotis, bread, etc.), refined, processed, packaged food with additives and sugars out of packets as is common and convenient?
– Do you eat home cooked meals or depend on canteens and hotels and takeaways?
– Do you travel a lot, subjecting yourself to different time zones, food, lack of sleep and stress?
– Does your life involve a lot of socializing with indiscriminate eating and drinking?
– Are you addicted to sugar and need to eat something sweet ever so often?
The list of poor lifestyle habits is endless. These are some of the reasons you could be steadily gaining weight. Each problem has to be addressed independently with a combination of life skills, dietary advise and regular exercise. There is no way around it. Whatever the reason for the weight gain, the solution is to eat better, exercise and change your lifestyle.
Here’s the problem – most people think an hour of exercise alone will solve everything. It takes more than that, although that’s a good place to start. Your lifestyle (as shown above) is important. What you do for the rest of the twenty-three hours counts far more than one hour of working out. This means change. A change in attitude towards your lifestyle and not just one aspect of it.
A new mind set and not just a new menu is what is required.
The real secret to losing weight and more importantly, keeping it off is your attitude. The ability to look at your lifestyle with a certain amount of objectivity and a critical eye and then take the necessary steps to change what needs to change. The ability to get the necessary professional help when required. It’s not easy to change a whole lifestyle. There are other people involved – family, friends, colleagues and boss who are probably helping you preserve the current lifestyle. Change may involve others and this is not always welcome. For change to be sustainable however, it has to be holistic.
Adopt a slow and steady approach. Help your body and mind gradually learn to eat better, exercise more, live healthier, sleep earlier, relax and breathe. Most importantly, learn to appreciate yourself and your efforts. Learn to respect yourself and your body.
Dr. Sheela Nambiar MD Obgyn
Fitness & Lifestyle Consultant, NAFC
Author – Get Size Wise & Gain To Lose (Published by Rupa)