Goal

Healthy Living

What is healthy living? Someone asked me recently if I’m the healthiest I’ve ever been.

My reply was "no." I said no because I used to trail run long distances previously and now I can’t/don’t. I'm not in shape to run 21 miles through mountains at high elevation. I'm not able to do an olympic distance triathlon at this time. So no, I’m not the healthiest since I used to be able to do those previously.

Pause.

With some reflection, I realized how narrow my response was. I only addressed musculoskeletal fitness and conditioning in my answer. And even within that answer I'm not sure I answered it fully. What about the mobility work and physical therapy I am doing to address long-standing mobility issues and imbalance in my neck, upper back, and shoulder? What about the work I am doing on my core and deep stabilizing muscles? What about the work I am doing on my hamstrings and glutes to strengthen them and address front to back thigh and hip imbalances and thus reduce the likelihood of injury to my knees and back?

Often moving forward feels initially like taking steps backwards.

I don't believe that health is simply our physical bodies. What about my mental, emotional and spiritual health? What about my diet, my digestion, my mood, my relationships, my interactions with work, my sleep, ability to communicate, my generosity? In these areas, I am healthier than ever, and significantly so. That is not insignificant. I am living a very satisfying, rewarding, and peaceful life. And it took work to get to this healthy place.

It was striking to me how limited my view was when initially considering my response to: “Am I the healthiest I’ve even been?”. I believe so much in integrated health. I know that there is complex and little understood interplay between these areas. I preach this to my patients, clients, students, friends and anyone listening. I believe that anything I want to impart to others, I need to first inhabit. “Do as I say, not as I do”, doesn't deliver.

But wow, not only did I not think about my full physical body - sleep, strength imbalances, stiffnesses, muscle activation issues. I considered performance in my answer. I have long known that performance and health are different things. Often doing the healthy thing means doing less. And this is remarkably hard to do in our culture. Our society screams - DO MORE, ACHIEVE, ACQUIRE! But deep, deep health comes from knowing our body and this requires sufficient slowing down to learn to hear and understand the voice of your body. I have long served as an interpreter and guide for physical therapy patients to know what their body is speaking to them. Teaching them - “motion is lotion.” Helping them release - “pain is weakness leaving the body.” Our body is us, so we need to not separate ourselves from it, but our body is also not the only thing we are.

When I partner with patients and clients, I frequently suggest that their path to greater health might be doing less of a certain thing so they can focus on underlying problems and direct space, time, and energy to address them. We struggle frequently to do the behaviors that are most helpful for us.

What do you think it means to live your healthiest life?

What healthy habits do you struggle to incorporate into your routine?

What resources are you accessing to help you LYHL?

How would a coach benefit you with this goal?

Dr. Elle

Preventing Rock Climbing Hand & Tendon Injuries: Part 3 - Dynamic Hang Boarding - Bottom Up

How do you hangboard? Are you a long-time rock climber who wants to climb for a lifetime? A beginner climber who wants to train right and train smart to prevent injury? Are you currently side-lined due to a tendon or pulley injury in your hand and want to know how to rehabilitate it? Are you scared by witnessing your friends get sidelined from finger injuries for months or years and you want to do what you can so this doesn’t happen to you?

https://youtu.be/NuPYYDr0MB8


This is a long-awaited Part 3 to our video series about preventing rock climbing finger, pulley, and tendon injuries in the hand. Make sure to watch videos Part 1 & Part 2, if you haven't already, in which Dr. Elle explains why injuries commonly occur in the hand and tendons/pulleys of the hand, how your technique may be contributing to this, and why strengthening your hand, not just your forearm is important for preventing this and rehabilitating injuries here.

In this climbing training video, Dr. Elle addresses a common training error in hang board training - when climbers only hang statically. Climbing is not static and the abrupt movements in climbing are associated with injury, especially when projecting a route or problem, when fatigued, and when under-trained - all of which are common. You need to bridge that gap in your training. Here is a bottom up way to improve your hangboard training to include more dynamic load to your fingers and make them more resilient to injury.

Comment below with any questions and let Dr. Elle know what questions you have. This shelter-in-place is a great opportunity to train weaknesses and correct imbalances in your body to get you climbing healthy for a lifetime.

Make sure to subscribe to our YouTube channel to not miss any of our educational videos.

TELEHEALTH for You!

Let’s get right to the point. The world is changing. Our health and the people around us are the most important thing. Even with social distancing and shelter in place or even quarantining if you are having mild COVID-19 symptoms, you can advance your health.

At Artisan Physical Therapy & Wellness, we offer both physical therapy and injury prevention programs. For physical therapy we help athletes and regular folks get back to their favorite sports and fitness routines, but can also help you if your goal is to get through the day sitting with back pain or you want to get rid of that heel and arch pain during those first few steps of the day or that shoulder pain in those certain positions reaching overhead and behind you. We have the expertise for all this and can work on multiple areas within one session.

While our physical therapy is limited to California and Oregon residents only, we offer wellness and injury prevention education and services for folks throughout the US and even globally.

Yes, we can help you live a healthier life even if you live in the Midwest, Pacific Northwest, New Zealand, Brazil, or Ireland. We offer wellness consultation worldwide! We do this specifically for rockclimbers and runners, but we can make sure you are healthy to get in a lifetime’s worth of laps at the pool, chasing your kids or grandkids, hiking the El Camino, or playing competitive ultimate frisbee. We are movement analysis experts and exercise prescription and can do this over video remotely. A good portion of the injuries we see come from good intentions, but lack of knowledge. We can give you the knowledge to prevent injuries before they even occur! Healthy for a lifetime. As our seasons of life change and physical goals and demands change, our self-care and fitness routines need to change too in order to optimize our health. Bring us your questions and let us help you answer them!

Honored to partner with you to keep you healthy for a lifetime.

Elle

Daily Dose of PT (#dailydoseofpt)

Yep, I made a hashtag #dailydoseofpt. Why? Because everyday for 2019 I’ve committed to myself, for my own personal health to do at least one physical therapy exercise. I’m not going to limit myself to one, but I will do at least one.

After some thought, I thought": “why not bring others along?” 365 exercises is a lot and sharing them is a lot, so the daily dose of PT will be shared just on one platform. For ease of use, I’ve chosen Instagram and the live story. It’s not that you won’t find any excerpts or references anywhere else - blog, Facebook, Youtube, Google+, or newsletter, but the journey will be unfolding and evolving on Instagram live and then kept up on the story for 24 hours.

Daily dose of PT - climbing gym edition

Daily dose of PT - climbing gym edition

My hope is that my quest for personal health and well-being will be educational and motivational for you and those that stumble across it. At the time of the writing of this blogpost, I am 9 days into the challenge, with 356 to go. There are lots of opportunities to participate. To not miss out, make sure you follow @artisanpt on Instagram and even allow notifications for live posts from me.

The focus to-date of the #dailydoseofpt has been primarily shoulder, neck, shoulder blades (scapula), and postural stability. Over the course of the year, the whole body will get covered, as needed by my own personal PT intervention needs. If there are regions or parts of the body, that you would like me to focus on, let me know and I’ll do my best to incorporate them sooner rather than later.

Thanks for joining on this journey to optimize health and wellness.

Together, let’s get moving!

Liz

Headstands & Handstands - April Daily Fitness Challenge

Routines are good for our life, and are healthy. But our body and our mind also thrives with some variety. Neuroplasticity is a concept in phenomenon increasingly studied the demonstrates how the brain is always changing. It changes for the Better or For Worse depending on the inputs that we put in.

The daily fitness challenge that I have been taking part in since October is a mix of both these. There has been the daily routine of consistently challenging the body, but also variety as how the body is challenged each day varies and also there has been a different theme each month - running, abdominal and core strengthening, hip and shoulder stability, pull-ups, and this month is something else.

So trying new things is good for the muscles and the joints, ligaments and tendons, but also for the mind and the spirit. At the beginning of this year I set out an overall theme for the year. This year I'm focusing on theme of produce, which basically means working on moving forward and creating, without too much of the limiting mindset that can stop you from creating and participating and sharing. So I brainstormed what are some things that I might like to learn this year and some challenges I'd like to take on. Enter headstands and handstands. I haven't given them much thought before and I've never tried to do them. But I thought why not try and learn this new skill and just see how I do.

Liz's baseline attempts at headstand with her watchful assistant and spotter.

Liz's baseline attempts at headstand with her watchful assistant and spotter.

Trying a new physical skill might mean some preparation is needed in order to do this healthily. Thankfully as a physical therapist, I have good insight into the strength needed and the flexibility needed to be able to put weight through my shoulders.

In trying this new skill I'm excited for the new opportunities that this presents for my body to grow, and strengthen, and learn new balance and ways to control itself. Some of my Approach will involve trying the overall skill, but I will also break it down into small parts to allow my body to have the best chance for success. I look forward to learning from others who are skilled in the area of handstands and headstands and learning some techniques. I plan to try some of the techniques described in this well done instructional video from the UK.

This month a focus on headstands and handstands I hope to be fun as I learn a new skill that I'm not good at. But I also know this will be a good compliment two activities that I like to do that strengthen my body in the other direction, namely, climbing and swimming. Both climbing and swimming are pulling motions and really activate muscles such as the latissimus dorsi and teres major which pull your arm down into more of a handcuff position. Pressing away in pressing overhead will be new challenges for me that have been overlooked and are often overlooked in rock climbers and swimmers, including triathletes, and lead to muscle imbalances, which put increasing strain on joints, tendons, ligaments, and muscles. The strain overtime can lead to pain and dysfunction and difficulty doing the activities we love.

I'll be posting videos primarily on Instagram so follow us there @artisanphysical, but also intermittently on Facebook and here on the blog.

Want to join in on this challenge? I'd love to have you join in and share your successes and challenges. Arr you going to try a different daily fitness challenge? I'd love to hear about that too. Have ideas and suggestions for Liz's next daily fitness challenge? I'd love to hear that too.

Let's get to the source, AND TOGETHER, let's get moving!

Liz

Awesome, Effective Advanced Shoulder Stability Exercise

Looking for an excellent, if not awesome, way to strengthen your shoulder.? We've got an exercise for you including a video demo! Here is one of Liz's favorite exercises that she is incorporating into her March daily fitness challenge - which is alternating between the hip and shoulder stability and strength.

The shoulder joint is a "ball and socket" joint. It has a lot of freedom to move in a variety of directions, which is means it needs stability and strength in multiple directions. This exercise is a constant isometric force into external rotation pushing out with the wrists which strengthens and challenges two of the rotator cuff muscles, in particular, the teres minor and the infraspinatus. As you push constantly out through the band you will simultaneously raise your arms overhead which works additional shoulder muscles including shoulder blade (scapular) muscles responsible for upwardly rotating it. These muscles include the serratus anterior and the lower trapezius, which when weak can lead to shoulder impingement, bursitis, and rotator cuff tears and injury. 

This is not an exercise to perform when your shoulder is very weak. For that you want to exercises that place less demand on your shoulder. If you missed it, a video we created for that is this:

Mixing things up with "easy" and "hard" exercises is good for a healthy shoulder. I've been doing exercises from each of these videos as I seek to have an even stronger and healthier shoulder than I already have.

Have you started a daily fitness challenge? If so, what are you trying?

Not started yet, but thinking about it? What are you considering? Even the considering, is a step forward and progress! The planning stages count for fitness and health.

Stay tuned for next month's daily fitness challenge which will be headstands and handstands! April is almost here. Would you like to join me? At this time, May is scheduled to be ankle and foot stability, so reach out with any questions or suggestions for that if that provokes some interest from you. This is particularly meaningful for those of you with "weak" ankles, foot and ankle pain, history of ankle sprains or foot/ankle fractures (broken bones). 

Let's Get to the Source, and TOGETHER, Let's Get Moving

Liz

March Daily Fitness Challenge - Hip & Shoulder Stability

I'm pleased to say that the daily fitness challenge that began in October of last year has continued, with a different theme every month. So far we have attempted daily running, seven minute workout, pull-Ups, 8 minute abs, and now.... drum roll please...

BOSU overhead ball toss.jpg

This challenge this month, as the title of the blog post indicates, is hip and shoulder stability. I'm excited about this month because they are very important and foundational to so many activities and preventing injury as well as rehabilitating injuries. I've had my fair share of injuries over the years and they have left they're mark. Now if I had been better about doing all my rehabilitation exercises for these various injuries, I don't think I'd be in the same place. I'm excited of the possibility that the asymmetries I have from side-to-side could diminish, and even, completely resolve!

 Doing all the exercises that your body needs is a lot of work. Can I get an amen? It takes a lot of time, a lot of motivation, and a lot of knowledge. I have the knowledge and a good bit of motivation, but not always enough time in the day. Anyone else have a hard time finding enough time in the day? These monthly-themed daily exercises that I'm exploring are an avenue for me to rotate throughout the body and pay attention to each area and hopefully be better off than the intermittent and sporadic exercise provided otherwise.

Unstable hips or, in other words, hips that lack the strength, endurance, and coordination to control themselves in space, can lead to problems from the low back all the way down to the big toe. Yes, even the big toe! You think you inherited that bunion from your family? Where you born with it? Is it rather from how you've moved and used your body over time? Let's take a look at your hip stability and then let's talk about it.

Knee injuries ranging from patellofemoral pain, runner's knee, ACL tears, meniscal injuries can all arise from a lack of hip stability. Lack of hip strength and control or endurance can also lead to ankle injuries such a sprained ankles and fractures and down the chain into the foot with overpronation, plantar fasciitis, shin splints, or achilles or posterior tibialis tendonitis or tendinopathy.

Shoulder stability is also really important and isn't straightforward. Think of all the motions that your shoulder can do and that is a sign that keeping it healthy will similarly take a lot of work. The shoulder joint or complex is actually made up of four joints: 

  • Glenohumeral joint
  • Scapulothoracic joint
  • Acromioclavicular joint
  • Sternoclavicular joint

All of these are controlled by muscle. So once again the strength, the endurance, and the coordination of these muscles results in the control surrounding those joints. In terms of stability, the most important muscles are the rotator cuff and scapular muscles. You can think of your shoulder blade, or scapula, as the foundation of your shoulder. If the foundation is crooked or unstable, this has consequences for the areas attached to it.

As I work on shoulder stability this month, I am emphasizing the rotator cuff - all four of the rotator cuff muscles - and the scapula thoracic muscles - think rhomboids, trapezius, serratus anterior - as well as the scapulohumeral muscles. If these muscles are strong, can work for long periods of time, and can turn on and off at the right time, there should not be clicking in my shoulder with movement, nor am I very likely to injure myself. Bear in mind that as I strengthen these muscles, I will also need to stretch them because strengthening increases the tone of the muscles and often the stiffness of the muscles and sometimes shortens the length of the muscles. And tight muscles can lead to injury and dysfunction.

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Because it is unwise to strengthen the exact same area day after day, I will alternate between hip stability and shoulder stability, doing one one day and the next the other day. Want to learn a great routine to do for these areas, reach out and we can schedule either a visit or a remote consultation for you fitness, wellness and health goals.

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Stay tuned for April's daily fitness challenge of headstands and handstands...

Let's Get to the Source - and TOGETHER - Let's Get Moving

-Liz

Arm Strengthening for Climbers: Hand Sloper Strengthening with Rotator Cuff and Scapular Stability

Are you a long-time rock climber who wants to climb for a lifetime? Do you want to train right and train smart to prevent injury? Do you wish your hand strength was better for slopers and other open-handed grips while rock climbing?
In this video, Dr. Bottrell introduces a quick series of exercises that strengthens your hand and forearm in open hand positioning for slopers while simultaneously strengthening and increasing the stability of the rotator cuff and scapular (shoulder blade) muscles and joints. Incorporating exercises such as these present the opportunity for better performance & longevity of climbing of a lifetime, decreased likelihood of injury.


Bear in mind these are general recommendations, and a certain amount of strength and fitness are needed.
Interested in what weighted ball uses in this video? It's the Gymnic Heavymed 2 kg weighted ball for resistance.

8 Minute Abs

Last month I did a daily physical challenge of running every day - with the goal of being healthy. Success! This month the physical challenge is "8 min abs". I've spent everyday of November (one day to go) targeting abdominal strength, endurance and control for 8 minutes. Now this isn't about aesthetic or beach body abs. Being able to do crunches and sit-ups are important but have been over-emphasized in the fitness industry for years. Having healthy appearing abdominal muscles - a 6 pack - doesn't mean you are in fact healthy. More specifically, it doesn't mean you are preventing injury. Abdominal strength and stability in combination with low back and hip strength and control make up what we physical therapists call "lumbopelvic stability" or "lumbopelvic control." This is something we emphasize in helping and rehabilitating persons with low back pain, sciatica, SI joint (sacro-iliac joint) pain, lumbar radiculopathy, herniated discs, DJD (degenerative disc disease), arthritis in the joints of the back, and stenosis. The back is connected to the pelvis, which is connected to the hips/thigh/femur. I often sing  to my patients and clients about the wisdom of the children's song: "the back bone's connected to the hip bone. the hip bone's connected to the thigh bone" (They love it, as you can imagine).

So me spending on this focused time on this region wasn't just sit-ups and crunches. In fact, it was much more perform leg and arm motions without letting my back move. I spent 8 minutes each day this month emphasizing a variety of challenges to lumbopelvic stability to promote and preserve a healthy back. I brainstormed a list of exercises and invited a friend to join me with this month's challenge. My list is long and varied. I challenged my abdominal muscles - all of them (rectus abdominus, internal and external obliques, and very importantly the transverse abdominus). I rotated through 48 different exercises these 30 days! There's no reason to get bored. And as we strongly recommend here at Artisan PT - variety is good and very healthy for us. 

Want an example of how to train the transverse abdominus? The transverse abdominus is the most important abdominal muscle to prevent back injury and recover from a back injury or back pain. Learn more in our video on a starter transverse abdominus exercise. PS - Side effects of this exercise include flatter stomachs! PPS - I won't be posting pre- and post- 8 min ab challenge photos, but will be enjoying the results.

 

Watch should the next challenge be? December is right around the corner!

Let's Get to the Source, and TOGETHER, Let's Get Moving!

Liz

Quick Yoga Sequence for Runners: Stretching with Some Core

New video out!

In this video, Doctor Elizabeth (Liz) Bottrell PT, DPT, FAAOMPT of Artisan Physical Therapy in Los Angeles, CA demonstrates a quick and effective yoga sequence for runners. Whether running your first 5k, training for a marathon, triathlon, or an ultra, you need to stretch. Stretching takes time and knowledge. In this video, you'll learn a quick vinyasana or flow yoga sequence that efficiently stretches your hamstrings, calves (gastrocnemius & soles), and hip flexors (Iliotibial band and iliopsoas) to maximize your time, as well as incorporating abdominal strengthening and control and cross training strengthening for the pectoral muscles and triceps. This fast routine, also trains balance, breathing, and improves motion in your back and abdominal muscles!

You can repeat and hold longer as needed. Do not hold your breath!

Pay attention in the video because you need to make sure you know which muscles to stretch. Follow-up videos will show specifics for a few other essential muscle groups for runners to stretch.

Try it and let us know what you think.

Chasing Your Goals

How 'bout them New Year's Goals?

It's been a busy summer transition into fall here at Artisan PT and in life in general. The seasons are changing even though here in Southern California it doesn't always feel like it. We have (hopefully!) made it to fall (finally!).  The Weather Channel app is telling me just a high of 74 deg, so I'm going to risk it and say: "we made it!" Here's to wearing layers, enjoying hot beverages, having comfortable workouts, and eventually enjoying falling leaves.

It's been 6 months since the last post about one of my goals: To do a race this year. September 19th, 2015, it happened. I competed in the Nautica Malibu International Distance Triathlon. 1.5 km swim, 40km bike, and 10 km run in the books!

As a special bonus, I got to race with good friends. Nothing makes it more fun than to create memories together!

As a special bonus, I got to race with good friends. Nothing makes it more fun than to create memories together!

It's been 9 months since I started training for the race. I was even training for the race 4 months before I signed up! Someone might ask - isn't 9 months a bit excessive for training for an Olympic distance triathlon? After all, it's nowhere near the length of an Ironman! My answer would be that it depends how you think about it. Starting in January of this year, I joined a local gym, which was my first traditional gym membership in the past 5 years. I hadn't lifted weights, for at least that many years, and I hadn't been running for at least 2 years. As a physical therapist, I wanted to be healthy and decided to practice what I preach.

One of my PT mantras is that: Your body WILL change, but change takes time!

Body composition takes time to change, as does developing muscle strength and hypertrophying (i.e. increasing the size of your muscles), so does endurance, and cardiovascular adaptations. I don't want you to think that in those 2-5 years I was inactive, I wasn't. I'm a firm believer in activity and varied activity; I was simply doing other exercise. The first few years of those 5 years I climbed a lot and hiked. Then I got back into biking and would do that whenever I could with some swimming sprinkled in there. My enjoyment of swimming while in LA has taken birth. Prior to living here, I worked it into my routine simply because I new it was good for me or 10 years ago because I needed to in order to perform reasonably well in my triathlon races, not because I enjoyed it. Here, I've grown to love it, particularly during the sustained Indian Summer months that we just survived through, yet again.

Having not run in so long, I knew that my hip strength, in particular, would be limited and this would in turn affect my running and my mechanics during running. If not addressed, I would run a much higher chance of becoming injured. If I wanted a healthy race, I needed a healthy base. I think it's noteworthy that at that time I didn't even know what race I was going to do yet alone what distance, sports, or time of year I'd be competing. I simply knew that I needed to start with the basics. So I worked on leg, core, and upper body strength, I stretched, and worked on all the imbalances that I knew I have. I worked on exercises that combine single leg balance and strength. 

We all have our issues and we all need to do our best to stay on top of them! I spent 3 months focusing on weight-training, stretching, and doing my "PT" exercises. Any runs I did were very short and focused on good form. Any leg pain? I would immediately stop. Any break down in form? I would stop.

I followed up that 3 month phase with cardio that built up all the way to my race. My goal was to do cardiovascular exercise - working in biking, swimming, and running - for one hour per day. As I got closer to race day, I started combining workouts (bricks) and doing 2 workout days to get the endurance for the multiple hours required for the race.

I had an almost unspoken goal of 3 hours for my race. I calculated this by simply combining my individual time from workouts for each portion of the triathlon. It was mostly "unspoken" because it was a dream time. I didn't know if I could do it all back to back that fast.

Well, I raced and I'm happy to report that I did it in 3 hours and 6 minutes. So close to my unspoken dream goal!

Most importantly, I was healthy the whole time and, in fact, my muscles and joints felt better than they had prior to my commencing training. I finished the race motivated to compete again, knowing that with the knowledge I gained from my training, I could reach my goal. Goals are important. Setting high goals are important. It helps you expand yourself and growth, whether you obtain the goal or not! Part of my purpose with the race, was not just the physical. I wanted to train my mental fortitude, too, in a way that I wasn't able to when I competed in triathlons previously in my 20's. I focused and learned from leaning into the discomfort that accompanies continued on when things get hard.

Don't wait until the pain comes, schedule a physical therapy visit with Liz at Artisan Physical Therapy to learn how to reach your goals healthily!

Let's get to the source and, TOGETHER, let's get moving!

Stayed tuned for future blogs to read about how to tweak my training from what I learned from the experience. Let me know any questions you might have.

Liz

Race Goal for the Year

My first blog post of the year highlighted some of the goals I had for the year. How are your goals coming along? Typing this question, alone, is making me want to stop and go back to recheck on all my goals and see what progress I'm making & if I'm forgetting anything!

The goal on the forefront of my mind currently is my goal to train and participate in a race this year. I'm so pleased to report I reached a milestone! I signed up! "What race?" you ask. Well, I am opting for a triathlon - the Nautica Malibu International Distance Triathlon - to be precise. Now I'm excited and nervous. I got a lot to learn about ocean swimming and I've got some training to do to hopefully "race" it.

What do I mean by "race" it? It has to do with your fitness level. I am fit right now in terms of overall health and wellness in disease reduction activity lifestyles and with respect to my body weight and composition. I could participate in the triathlon event and complete it, possibly even this week, but it wouldn't feel good. I want not to simply finish it - although I think it is a great feat. I want to prepare, train, and give it my all - to go fast - that is, to "race" it. Let's be clear when I say race or fast, I mean my fast (not going to be winning any races here)!!

I'd love to hear about what your training for in life, how you're learning to persevere and be disciplined, and elevate what you think you're capable of. For me this all fits into the bigger picture of learning to live more WHOLE-HEARTED (my theme for the year) and even helping people living healthier, more satisfying lives with my work at Artisan Physical Therapy. Also let me know what training questions you have!

Together - Let's Get Moving!

Liz

Liz Bottrell - Artisan Physical Therapy - biking

New Years Goals

Do you have any new years goals? Some call them resolutions, but others of us are put off by that term. Goals, however! Those are worth having! Still others, including myself, select a theme for the year.

My theme for the year is: whole-hearted.

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