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

Sleep Hygiene? Part 2 of 2

Not sleeping well is a detriment to healthy living and healing. Now that you have considered the concept of sleep hygiene from Part 1 of this 2-Part series, consider the following list of habits to develop in order to improve your quality of sleep, allowing you body to heal, recover, and reenergize:

1. Exercise daily - but not too close too bedtime. It varies, but exercising too late at night can disrupt sleep, if performed 1-2 hours before trying to sleep.

2. Limit screen use (TV and social media) before bed - Neither allows you to focus and declutter your mind nor control the imagery and messages you let in. Being on the screen is also often about productivity and on social media easily brings us to envy and comparison, both of which do not promote rest. The blue light from the screen is not good for you. You can have your phone dim and switch to orange or black/white light later in the evening to assist you in this regard.

3. Prepare things for the next day ahead of time, so that your mind does not need to focus on them - e.g. set a reminder in your calendar so you remember to email that person and don't have to worry about keeping it in your mind. As you do this, move more slowly, so your body gets the cue to slow down.

4. Meditate or contemplate 10-20 minutes - in contemplation you have an affirming mantra/phrase that you keep repeating bringing your mind towards as it wanders.

5. Limit talking - decreasing your motor output will help you slow down and unwind both physically and mentally.

6. Read with low light:

   • Something engaging, but not upsetting

   • Consider something about positive human potential

   • Try not to read something so light that your mind doesn't have to focus

7. Stop being productive - don't work or study right up until sleeping, instead create a buffer zone. 

8. Practice being in the present moment - pay attention to your body, your breath, enjoy physical being with your family/partner/roommate. This is a perfect time for cuddles and getting cozy with pillows and blankets!

9. Breathe - work on slow breaths from your abdomen to ensure your diaphragm is properly facilitating your breathing and thus promoting the parasympathetic system to be active (which is your "rest and digest" system).

10. Turn lights low as you prepare for sleep and then fully dark to optimize deeper sleep states

11. Rest in bed before attempting to sleep

12. Sleep in a cool room. Too much heat can be disruptive to sleep.

13. Create quiet environment: Use ear plugs or head phones to limit outside distractions & silence your phone

14. Listen to calming, quiet music; podcasts, talks, or books that are quiet as well as affirming and positive about the human potential. Use a timer to have this turn off after 15, 30, 45, or 60 minutes, depending how long it typically takes you to drift into a dream state. I bookmark my starting point in books so that I can easily come back to where I started from - some days it takes a whole 30 minutes for me to fall asleep, sometimes I am no longer listening within 5 minutes!

15. Journal to process thoughts and concerns from the day to limit them from looping in your mind

Do you have other things you practice and find helpful? Comment below.

Oh! FYI - You shouldn't have pain with waking up from sleep. This may indicate you need help from a physical therapist, but it may also mean that you need to sleep with different pillows or mattress to obtain more healthy and restful sleep.

Happy sleeping!

Elle

Don't Be An Ageist!

Being an ageist, it's not cool, right? The first step to not being an ageist is to examine how you view yourself. I think ageism is quite common in US society. People are often self-limiting in what they pursue and what they routinely do simply because of the number of years under their belts. It's likely that if it's not something you actively think about or have noted in society, that it is present in your life.

Our society gives us this imprint and expectation of behavior that we tend to fall in line with and don't question. Questioning, by the way, is something we can do in our minds or with our actions. I've observed that in the US getting older means that hanging out with friends no longer means going to the park, or running around the block, or going on a bike or skateboard adventure, climbing a tree, or building a fort like it did during our youth. It means things like getting coffee, going out to eat, and watching TV or a movie, or sitting at a concert. Our communal time becomes less active and increasingly sedentary.

Also the types of movements we do become less and less playful, more rigid and predictable, less demanding of balance and coordination, and overall slower and slower.  Physically it means that our body is less adaptable to face the challenges of the world whether that's moving quickly to catch something that's dropping or falling, running across the street to get out of the way of a car or get a child out of the way of a car, catching ourselves from a slip and trying to prevent a fall, impaired balance and coordination, and later in life as a senior reaching for high objects off the shelf, lifting something overhead, getting out of bed or off the floor. Yes! I’m not exaggerating - a lot of the problems I see in older patients comes from this ageist attitude and habits. Our body responds to what we do, so less and less activity means more and more limitation. I see this behavior in younger patients, even though the habits often haven’t yet caught up with them, but sometimes it has, well before they are a senior. It makes me sad. But it’s also something we can change!

Our body thrives with variety. These good bits of stress, allow our body to make adaptations - adaptations such as quicker reflexes, better movement patterns, better proprioception which is knowing where your body is in space. As a result, our tendons and muscles are stronger in more varied positions and speeds. This is important because, injuries in daily life usually occur at higher rates of speed, so integrating faster movements into our regular life and training (once we have good movement patterns established at lower speeds), decreases this likelihood of injury in our everyday lives.

Ageism has negative consequences for us not only physically, but also emotionally and mentally. Mentally it's limiting because we've decided certain things aren't for us because of our age. We've decided that's for young people, we're too old for that, we'd be too silly or look too silly, we wouldn't do well at it. So we do less. How we live part of our life is how we live our whole life. If we limit ourselves physically, we are doing it mentally, and emotionally. We are not challenging ourselves.

Emotionally we miss out as well when we don't have playful movement such as dancing, or roller skating, or playing tag, games, or wrestling with children or grandkids. Brene Brown, a social worker and vulnerability/shamre researcher, can tell you more about this in her book, "The Gifts of Imperfection." In her 10 Guideposts to living whole-heartedly, a.k.a happily, (based on her research), you will find play as one of the required components to living this better life. You can also learn more about her research in her TED talks and now on her Netflix special.

Are you an ageist? Are you limiting yourself simply because of your age and what folks around you are doing? I don't want to be an ageist, not of my patients and my clients, nor of myself. This starts with how I view myself. In order to do this, I need to not view myself through an ageist perspective. What are some things that I do to combat this? I skateboard from my car to my classes as a graduate school instructor at USC. This alone makes me feel ~20 years younger. I snowboard. I adventure and play in the mountains doing things that get me dirty, require me to adapt to the environment, expose me to weather and natural elements, and make me work different every time. I climb, run, and mountain bike in the mountains.

One of the most recent areas of growth for me in this area has been incorporating a discipline of regular dance in my life. This is not choreographed, group movement. I throw myself regular dance parties, often in my living room, or the living rooms of friends. The music goes on and I let my body be creative and explore in response to the beat, the melody, the lyrics. It's been so fun, freeing, and even healing for me. I feel the change in my body, my mind, my emotions, and even my spirit. Every know and then if you follow me on social media, I share some of this dancing, because I want to break down these ageist walls we've built up or allowed to be built up around us, that keep us imprisoned in this limited mindset and perpetuates this negative belief in society.

I started this simply. It didn’t require any additional equipment. Just a little bit of space, my phone, and a song that I can move to. Early on it was simply one song after a work day. Often times I’d find myself feeling better and playing more songs. Now I have a “Daily Dance Party” playlist I’ve created on my phone. I’ll put it on shuffle and have built up to 20 minutes that I incorporate into my 20 minute of daily cardio. This has been so good for my mood and outlook and incorporates unpredictable, varied movements, balance, coordination to balance out things that are more predictable - running, swimming, biking for cardio.

What steps can you take to be less of an ageist? Remember it starts in your own life and how you're limiting yourself. As you try more activity, be wise - start slowly, give your body time to adapt, and get help (perhaps PT) if you need to get some basic, foundational movement - strength, coordination, mobility - down.

Together, Let’s Get Moving!

Liz

Give Swimming a Try!

I was never a "water baby" - that is - I was never a kid that jumped into water whenever I saw it. I only wanted to get wet if I was dirty, sweaty, or super hot. This followed me into adulthood, so choosing swimming as a workout was not something that happened for me. That is until I was forced to. By age twenty I had injured my knee significantly twice. These ACL knee injuries (anterior cruciate ligament) had ended my soccer career prematurely. I had to wait a few months for ACL surgery, but wanted to stay active, so I did early morning walks with arm motions to get a whole body workout and I started swimming. 

I hated swimming. I hated it as I packed my swimsuit & towel, traveled to the pool, dressed, walked onto the pool deck, jumped in, and swam the first lap.  Do you see the trend? I hated it. But by the second lap it wasn't so bad. It was a quick and very intense workout for me. 20 minutes and I felt like jelly afterwards. All without any impact or pain to my knees! The workout was, in fact, so difficult for me that my cheeks tingled afterwards. Anyone else? Probably not. 

Flash forward to over a decade later and swimming is high up there on the things that I really miss about LA. Swimming laps outside midday on a sunny day is one of the most meditative and mind clearing experience I have. I get a whole body, no impact workout to balance out my running, hiking, biking leg workouts with inclusion of arm and abdominal conditioning and my mind gets to wonder through future ideas and possibilities as well as reflecting back on experiences and relationships. Oh and my cheeks don't tingle anymore.

So give swimming a try! 

Want to make sure you're healthy while swimming? Wonder what swim strokes are right for you? Wonder if you're stroke technique could lead to an injury? Wonder how much to do? Necessary stretches and strengthening? Let's chat. (Also possible future blog post topic - what do you think?)

Already swim? Where is your favorite place to swim?

Together - Let's Get Moving.

Liz

6 Effective Tips to Less Back Pain with Sitting

Do you have difficulty completing work due to back pain with sitting?

Does your low back pain limit your social life with things like sitting at a restaurant, driving, and sitting through a movie.

Low back pain with sitting is common with disc and muscle injury.

To get yourself feeling better, try these 6 simple tips:

1. Use the back rest on your chair
   • Sitting up is hard! 
   • Give those muscles a rest by allowing your back to use the support of the backrest.
   • Don't sit at the front of your chair
   • Keep your chair close to what you are working on, so you can stay all the way back in the chair.
2. Use an extra and portable back support
   • Chairs are often not designed ergonomically for ideal posture.
   • Chairs are not one size fits all! Our bodies differ wildly in shapes and sizes from one person to the next.
   • You should maintain the same amount of curve in your back while sitting that you have while standing.
   • To assist with this, I recommend some thing like the Wonder Roll, which you can find online at www.wonderroll.com. It changes support quickly and easily while being portable, yet can stays in place on your chair with a simple strap.
3. Take frequent breaks
   • Let your body heal and get stronger, by planning and not sitting longer  that your back can tolerate. 
   • If it starts every 30 min, get up every 25 minute, etc.
4. Make sure your hips are flexible
   • Remember the song you sang about the human body? "The back bone's connected to the hip bone, the hip bone's connected to the thigh bone..." (You get the point).
   • Stretch the back side of your hips both the muscle and joint, so your back isn't being strained.
5. Increase the strength and endurance of your low back muscles
   • If your back muscles are tired, they will do one of two things.
     1. They will start to complain and be your source of pain.
     2. They will stop working and let you go into poor posture thus putting bad stress onto the passive structures in your back: discs, ligaments, and joints.
6. Watch your posture
   • If you saw your posture from an outside perspective, you might be horrified!
   • Set regular reminders in your calendar and alarms on computer and phone to remind you even when caught up in tasks and projects requiring your full mental attention.
   • Give permission to those around you to remind you when you are sitting with poor posture, so you spend less time there and thus strain your disc, ligaments, and muscles less.

Thanks for reading. If we get enough interest, we will make some videos about how to sit with less back pain. Leave a comment about how it works for you and what tips you use.

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

Climbing clinic: Upper Body Strengthening

An Upper Body Strengthening Clinic for Climbing Injury Prevention and Performance

Sound interesting? Join Liz tonight at Stronghold Climbing Gym in Los Angeles for an interactive clinic on upper body strengthening for injury prevention, performance, and longevity for climbers. Climbing can lead to overuse problems and muscle imbalance injuries. In this clinic you will learn principles and specific strengthening exercises for shoulders, elbows, and hands, to reduce the likelihood of such injuries occurring and to learn safe ways to strengthen.

7:30-9:00pm

What is Manual Therapy & Why is it so Effective for Pain?

Liz Bottrell, PT, DPT, FAAOMPT, manual physical therapist and owner of Artisan Physical Therapy in the Echo Park neighborhood of Los Angeles, CA explains what manual therapy is.

Manual therapy, or "hands on," evaluation and treatment improves motion, mobility, decreases stiffness, tightness and pain, as well as improving circulation and speeding healing. The healing hands lead to areas of injury and work them out. It is a place where science and art meet.

Do you want to get better as soon as possible? Do you want to see an expert? Have you not seen the results that you hoped for with prior physical therapy. Maybe your therapist wasn't highly skilled in manual therapy. Liz is a fellow of the American Academy of Orthopedic Manual Physical Therapist (FAAOMPT) - her specialized manual therapy training and skills set her apart from other physical therapists.

See a manual therapy specialist and experience the difference in your day to day - the ease of movement, the reduced pain and stiffness, and improved muscle activation (read strength, coordination, and balance). All of this helps you sleep, walk, run, stand, reach overhead, and so on more easily and with less pain.

Combine quality and focused physical therapy with your needed exercises and necessary modifications and get ready for amazing results beyond what you though possible!

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