MOVE: 8/28/15 More is not Better...BETTER is better

I have worked with athletes (a term I use to define anyone in pursuit of any physical endeavor that pushes their current physical, mental and perhaps spiritual capacity) of all types over the years. In almost every case they walk in frustrated by injury, with the same question: "when can I do more _______?"... insert weight, reps, sets, laps, miles, repeats, the list goes on.  Regardless of how many times I am asked, I always give the same vague, yet honest and seemingly frustrating reply: "It depends".

Their next logical question: "depends on what?"

At that moment, in terms of their future achievement(s), we can start covering real ground as we build their recovery and training picture by accounting for the many variables and nuances that make them the unique athlete they are.

We might start with age:  Are they a 14 year old female or a 52 year old male, or somewhere in between?

Then, movement quality analysis: Is their movement efficient or not?

Then training history: What is their current training load (noticed I said "load" and not "volume" or " intensity"...There's a difference and yes, it matters; a lot)?

Recovery patterns: How much sleep do they get?

Nutritional patterns: What's their nutrition like?

Social Determinants:  How are their relationships? Supportive of their goals?

And on, and on as we gather some of the information that helps them achieve better results....not by training more, but by training BETTER.

Common Case 1

Take the 14 year old female who wants to increase training load, perhaps "mileage" in a runner.  After all, she's just starting to realize her athletic potential, that she has the engine to be a high performance machine.  We all want to know how fast and how far we can push ourselves, but when we get into the details, it's a trickier story. Considering, for example, that the bones of a 12-14 year old female are typically in a high state of metabolic activity as she is in the midst of one of life's biggest growth spurts, second only to the growth spurt seen from birth to about 3 years old, should scream "caution"; that we should increase mileage and speed in a very deliberate way based on the best science available.  We see injuries from mileage jumps all too frequently in this age group, but with proper planning it doesn't have to happen.  By the time the athlete reaches 15 the risk may be lower, assuming her mechanics (movement efficiency) are good and there's been adequate focus on building the strength/flexibility/coordination needed - all part of proper progression.

Common Case 2

Now how about that 52 year old male version of this endurance athlete?  How many 50-something endurance athletes have you met who DO NOT have a "tendon issue"?  That's right, not many.  Seems a little sarcastic, but the fact is, as we age there is a drastic decrease in the tensile strength of our tendons.  There are several key reasons for this, and even though an in-depth analysis is a bit beyond the bounds of this write-up, it's not unlike the picture we can paint of the 14 year old when we consider all of the training variables. Also not unlike the 14 year old, with knowledge of the right training load and corrective exercise, crisis (unfortunately, for any serious athlete an injury feels like a crisis) can be averted.

The point is, even though it seems contrary to what we, as athletes, like to tell ourselves (which is sometimes reinforced by other parents, coaches, training partners, etc.)... more is not always better - BETTER is better. Yes, there is a science to it and when followed, the results can be extraordinary.

Better performance is the result of better training, which comes from better knowledge, which comes from....how should I put this, human performance nerds like me I guess.

Happy to answer your questions, reach out anytime.

 

Justin Bagley, PT, DPT

Doctor of Physical Therapy

MOVE: 8/21/15 Compound Earnings - Health Asset Style

Spoiler summary: It's only a short investment window, but it might be about to open.

For the last two weeks I've been talking about the idea of reaching peak fitness right at the moment you need it.....when demand is also at its peak.  The idea is simple, have "the most" when you need it most to make sure you can overcome the challenges and achieve.

• I talked about managing both the training load and the fatigue levels to ensure growth without breakdown.

• I talked about the benefit of using a phased approach (3-6 weeks per block) with distinct objectives/goals of each

• Last, I talked about the "peak" being a brief moment - temporary.

But what if you're ready to build a dynasty?  What if it's not a blip on the radar you're after, but long-term success?  What if your goal is to be the very best version of you for as long as possible?

Back to the financial analogy.  If, as I drew the parallel last week, we can view our fitness as something similar to a bank account.....something that we can add to (making deposits) or draw-down (write checks) or even leverage to accrue assets (pay off loans), then understanding how to turn a momentary peak into permanent growth isn't so complex.....it's about finding a new challenge and reinvesting the dividends over and over, which, as anyone who's played around with a compound-interest calculator can attest, is powerful stuff.

After making it through the heat of summer for example your aerobic system will have improved slightly due to the normal adaptations of acclimating.  Your heart rate may be slightly slower for example and your core temperature will have dropped a bit.  Said another way, when the peak temperatures are over we will be left with just a bit "extra" capacity. Is it possible to invest in fitness at that point and get a compounded effect?

To a certain extent the answer is yes.  It takes about 3 weeks for the normal summer-fitness adaptations to wear off once the weather breaks. So, assuming we're healthy enough to do so, that's three weeks to build on the assets accrued.  

But is 3 weeks really enough to do anything meaningful?  Although most people won't go from couch potato to super-athlete in 3 weeks, the short answer is YES.

Consider these 2 studies for example:

• Women who performed a total of 6 hours of high-intensity training over 2 weeks improved ability to burn fat considerably or maybe better yet

• As little as 3 reps of 30 seconds of intense activity has been shown improve the blood-sugar/insulin response in young sedentary men.

We're not quite there yet.....but eventually the hot weather will break.....and when it does, it might be a great time to make sure you get the most for your summer effort.

Reach out with questions.

Have a great weekend,

Mike E.

ENDURE 8/14/15 - Training to Peak Part II

Spoiler Summary - so if timing is everything and it's simply about steadily increasing demand until the goal is met, then how fast can we get from point A to point B?

[in my best soap opera announcer's voice.....]

 

Previously on the prevention blog Mike was talking about timing peak performance with peak demand, that time of the year -- either because of external factors or personal goals -- when we've got to be at our best if we want to keep the risk of injury/illness under control.  He reviewed 4 critical concepts: (1) understand that the "peak" is temporary and typically no more than a few times per year, (2) making sure the end goal is realistic, we're talking about a biological system here, it doesn't change overnight....at least not very much, (3) baseline testing to ensure we know where the starting point is (it's much easier to predict when you'll get "there" if you know where "here" is) and, (4) the difference between getting there in the fastest means possible and red-lining the system...and how fine a line that is, so use controlled acceleration.  

 

Now, back to our story....

__________________

 

When we get through the mental work of deciding we are ready to make a change (which ironically can take a long time), we want results NOW.....faster-even if possible.....we go from nothing to everything and want to see the results.  Although telling someone that that it could take weeks or months (or years) to meet their goals is never a favorite conversation, we often have to.  And so, it has to be about progress -- seeing improvement and collecting little victories until we get "there".  Of the 4 critical concepts, knowing how fast we can "ramp" the system stress, is usually where things go wrong.  If it's an external demand (like summer weather), there's not much decision - we just adapt - however preparing is no less important if we want to stay healthy & safe while it's happening.

 

For a very long time, the 10% increase in total stress (or "volume" or "load" as it's sometimes called) per week rule of thumb was the prevailing wisdom of what was safe. However, since there wasn't any gold-standard science to back it up, researchers began to study exactly how fast they could ramp athletes up.  What they found was that most athletes could ramp faster than 10%, that although "per week" was a convenient unit of time to measure, it wasn't perfect and that every athlete had unique considerations that could make or break the effort.  Of course, this makes total sense - (A) we have weeks where we can emphasize thework and weeks when we must put some extra recovery in the bank, (B) the body likes consistency and routine, so for maximum benefit we have to keep adjusting variables to challenge it to grow and (C) although guidelines are great, one size DEFINITELY DOES NOT fit all, customization at the individual level matters.

 

So how do you know what's reasonable or right for you?  In short, the easiest way is charting progress. If you like paper and clipboards, write it down.  If you like numbers or calendars, build a spreadsheet.  If you want the information but hate tracking stuff (and have the means) hire a person or a device (wearable, app on smartphone, etc) to do it for you.  Although there are many variables you could track - times or reps or sets or temperature or whatever - some of it is helpful and some of it is noise.  The latest research, when it comes to reaching a peak at the right moment, tries to answer 3 basic questions:  How many assets exist? (i.e. long-term fitness)? How many checks haven't been cashed yet (i.e. short-term fatigue)? What will my account balance be once everything is cashed?  Although the terms used are something a bit more confusing: "chronic training load", "acute training load" and "stress balance"....the concepts are the same; and timing the peak is about managing the balance.

 

To do this, most athletes use "phases" of training usually between 3 to 6 weeks in length, to meet the goal.  Depending on the goal, each phase might be repeated multiple times.  The goal of the first phase is to accrue assets (put money in the bank) - this is called "base" training.  In the second phase it's about pushing the system to grow (borrow from the bank and steadily payoff the loan) - this is called the "build" phase.  Finally, the third phase is about restoring a positive balance ("owning the asset" by paying off the loan) - this is called "peaking". It's important to do all three phases.  For many folks it's tempting to try to skip phase one, but almost always this results in problems.

 

For our example of peaking with the heat - this might mean low-intensity aerobic exercise starting in the middle of May.  This would be generally easy and consistent - like a walking program with stretching at the end and would last for a few weeks (base).  Then, somewhere around the first weeks of June it would mean steadily increasing the intensity, maybe adding in some hills or faster bouts, building to a jog or adding some short interval work like strength exercises (build). Then near the end of July, the shift would be toward peaking, increasing the intensity (in this case the heat would do this for us naturally) and backing down the stress-load so that early or mid-August we're strong, fit and rested.

 

Although not that complicated, it's not easy either.....it's an active process and it takes work.....but with the right timing and plan it's work anyone can do.

 

Winter-peak training starts with base training before you know it.....let us know if this is your year!

 

Have a great weekend,

 

Mike E.

ENDURE: 8/7/15 Training to Peak

Spoiler Summary - matching peak performance with peak demand is the essence of all training plans.....and it's doesn't have to be complicated.  Nuanced? Yes.  Complicated, not really.

Within 3 minutes of starting my second leg of the River to Sea relay (a 91 mile team relay from the NJ/PA border in Milford to the Ocean at Manasquan on a 90 degree day) I knew it would be about energy management.

I wondered if I had tempted fate by discussing the impact of heat on the body in my newsletter post from the day before (last Friday) and thought about how I was going to keep from imploding in the heat.

I wondered exactly how fast the heat would drain me. I wondered if I had enough ice to keep my body temperature down.  I wondered if I had hydrated well enough.  I wondered if there would be any shade along the way.

Over the next few miles I kept a pretty regular eye on my heart rate.  As a nearly perfect "tachometer" for the body, I knew I if I allowed it to raise too much, I risked fatiguing early and the problems that come along with.  However I also knew that if I stayed awake at the controls and kept my body temp down and my heart rate where it needed to be, I could turn in a good enough time to help my team.  Admittedly, it wasn't the most fun 9 miles I've ever run.

With that in mind, I figured last week's note on heat and the next day's test might be the perfect segue to take another step in the discussion of readying the body for "peak demand" -- timing training-efforts (MOVE+FUEL+RECOVER) so that peak-fitness capacity coincides with the time(s) when our bodies are being pushed to their limit in order to safely get to the other side (ENDURE).....so here goes:

It starts with designing a training plan:

Step 1: "Peaking" occurs for only a moment of time.  We might like the idea of staying at our peak for a while, but in the truest sense of the concept, that's impossible. So we begin by deciding when we want that moment to be.  We try to answer the question, when during the year will the demand, either naturally or because we've planned it that way, reach its max. From a work perspective, this is usually the summer and the winter - since extreme temperatures sap our energy so quickly.  However, for some folks a big life event (active vacation, big sporting event, etc) can add in another peak or alter the schedule entirely.

Step 2: Next, we try to quantify peak-demand a bit and make sure it's realistic.  What kind of effort is going to be required?  Will it be like actually climbing Mt. Everest or something more like riding the Mt. Everest ride at Disney?  It's really important to get this right -- understanding what "success looks like" is critical and being accurate in the energy demand allows this understanding.

Step 3: Since we now know what needs to be done (finish line) and by when (time oriented) we want to find out where the starting line is.....also known as "baseline testing". This tells us what sorts of assets we already have in the bank and how much ground we're going to have to cover during training.  Baseline testing can be done any number of ways and it should include measurements of all of the critical functions that we'll be required to perform during peak-demand.  For a running event it might be mostly measures of endurance and movement quality.  For a work-related task it might require lifting or lowering something, etc.

Step 4:  Once we know when the peak is, what's required and where we're starting from we can slowly insert training sessions, progressively increasing their stress level (by adjusting frequency, duration, intensity) until the goal is met.

First know where you want to go and when you want to get there. Then know where you're starting and progressively layer training-stress onto the system until capacity meets demand -- simple enough right?

The good news is, it really is that simple.  The not as good news is, knowing how fast you can ramp between point A and point B and exactly what type of training stress is the best is the critical balance between pushing to the limit and over-doing....and that's a fine line.

To be continued.....but if you just can't wait - definitely reach out.

Have a great weekend,

Mike E.






 

CONNECT: 7/24/15 The Foot - Our Connection to the World

Spoiler Summary - It tells us what we're on and where we're at. It acts as our platform and our propulsion. It's the base of our pyramid.  So why do we abuse it so much?

The human foot is basically a bag of bones. Sure it has some muscle and soft tissue, but a little like the hand, it's mostly made of oddly shaped bones and vessels wrapped in skin. But, if you think about it, the foot has one of the hardest jobs in the body and requires amazing versatility.  

• It's sensory organ: feeling for the subtle changes in the texture of what we're standing or walking on and relaying those messages a very long way (in terms of the body) back to the brain for interpretation.
• It has to take commands: stiffening or loosening ever-so slightly depending on the message it gets back from the brain.
• It has to be a shock absorber: conforming to the surface we're on sometimes
• It has to be a propeller: acting like a springboard so we can walk or jog or run
• It has to be a platform: providing a stable base that the entire body can balance on when we're standing.
• And we expect it to be a workhorse: providing hours of work on a daily basis, for years and years without complaining.....too loudly.

Truly, it's one of the most important pieces of equipment we own.  So why don't we treat it that way?

Now, to be fair, not everyone abuses their feet.  I've met many people who are of the mindset that a good pair of shoes is a wise investment and that a dry pair of socks is an absolute must.  I've met people who inspect for cuts, nicks and cracks in the skin, who make sure it remains flexible and well maintained, and who exercise the foot just like they would any other body part......but not many.

It's more common to meet someone who crams their feet into any available boot or a into a shoe that looks cool, not even considering if it's a good fit.  It's rare to see someone who gives the tissues a stretch-break or invests any time in keeping them strong; and it's very rare for a person to ask about ways to keep the foot healthy.

So, just in case your "dogs are barking" by the end of the day and you never stopped to think about how best to give them a little TLC, here is a list of "tips to think about" in regards to the foot:

1. Shoes *disclaimer* beware not to go too far, at some point shoes are shoes....but up to that point fit does matter.

A. Start with shape -  Think about the way your foot is shaped.  Some people have longer feet which appear to come to a point in the middle (at the 2nd or 3rd toe).  These folks will usually do fine in a traditional shoe.  Others have a more square forefoot - in the same shoe they will suffer.  Some feet come to a point, but closer to the big toe than the mid-two, they need a shoe that matches the shape.

B. Consider the mobility - if you have a highly flexible foot ("flat") it is absorbing a significant amount of shock every step but doesn't propel as well.  A shoe with some support or stiffness can help offset this pressure and provide a bit more spring.  On the other side, if you have a high arch and a rigid foot (not much motion), you may want more shock absorbing material between your foot and the surface, so consider a softer shoe.

C. Replace when needed - as the material of the shoe breaks down, they are no longer doing their job.  Even if the upper (leather or other) looks fine, if the material is worn or no longer providing the proper level of stiffness, they are changing the angle of strike and motion. 

2. Rule of opposites - If you sit all day, get up and get moving your feet need exercise like any other body part.  If you stand or walk all day, give them a break and get them elevated for a few minutes.  As with any other body part, balancing the stress-load with recovery is the only way to maintain health.

3. Keep an eye out for swelling - it's not uncommon for feet to swell a bit during the day.  Static postures allow for fluid to pool with gravity.  If you've noticed the sock-line a bit more pronounced this time of year, it's likely that there is increased pooling and therefore increased pressure.  A few minutes with the feet elevated can go a long way. If it's a common occurrence, you might consider a compression sleeve or sock that you can buy at any local pharmacy.

4. Foot massage? - Although it's pretty hard to find someone who wants this job (yuk!), a golf or lacrosse ball can be a very easy way to get the benefits of kneading and rolling-out the tissues.  It doesn't take much pressure, just some rolling on the soft tissues of the arch to keep them supple and moving.

5. Keep them strong and mobile - there aren't many, but there ARE foot muscles. Just like any other muscles they can get stiff and weak if they're not being exercised regularly. Although some of these are harder than they seem, HERE are some good examples of foot exercises.

Of course there's more to it than we could ever fit into a single post....so reach out with questions.

Have a great weekend,

Mike E.

RECOVER: 7/17/15 Five Things You Can Do to Reduce Your Risk

Spoiler Summary - if there ever was a vulnerable spot, this seems to be the one. 5 easy things you can do to reduce your risk.

There you are, walking along, thinking about your day.  You put your foot down, feel your weight shift just a bit as the surface you're walking on tilts ever-so-slightly, almost unconsciously you correct your balance and keep moving.  This is how the ankle and foot are supposed to work....and in most cases this is exactly how it does.....but not always.

Ankle injuries are one of the most common injuries in active folks -- the most common sports related injury and very common on the work site and at home.  It's not surprising perhaps, all of our body weight balancing through a relatively small area is quite a challenge....and as life moves faster and bodies get bigger, the forces across that area are larger.

However, the good news is that ankle sprains can often be prevented with a few simple tactics.  Here are the top 5 to consider

1. Feet - they're not super wonderful to look at (or smell) in most cases, but how your foot strikes the ground can tell you a lot about your risk.  For individuals who tend to have very high/stiff arches it's not uncommon for more weight to be placed on the outer edge of the foot while walking.  Not unlike a poorly packed vehicle - all the weight on one side increases the risk of a "rollover".  Maintaining flexibility in the feet and ankles can help.

2. Footwear - it's not only what's going on inside the shoe that matters. Choosing the right style of shoe for the conditions and lacing them properly to make sure they are worn snugly (but not tight) can ensure that the foot remains properly positioned within the shoe on every step.  Extra motion within a shoe (sliding/shearing) can greatly increase your risk of an injury, especially on uneven terrain or in situations where you must move quickly.

3. Stability - because of its design, the ankle requires a significant amount of active-stabilization, i.e. muscles working to steady things.  Unfortunately, as we age and as we have greater amounts of sedentary time, those stabilizing muscles can weaken considerably. This can also be the case in folks who always wear high-top shoes/boots or other external bracing. Exercises that improve stability and muscle timing can produce impressive results.  Whether working them into your gym routine or just practicing at home, they can have a strong impact.  

4. Flexibility - not too much, not too little, just right! Although some people have chronic joint laxity which puts them at risk for injury, this is less common in the workplace.  Most individuals, especially those who wear boots frequently, will develop stiffness in/around the ankles.  The achilles tendon is often very stiff, which greatly increases risk and the top of the foot (tibialis) isn't usually much better.  Although there isn't typically a need for long bouts of stretching, short/regular (daily) flexibility exercises can go a long way to reducing compression of the joints and pain syndromes.

5. Priming for timing - as I alluded to in the first paragraph, the foot and ankle, when healthy, are so finely tuned they adapt almost instantly and unconsciously to the surfaces we stand/walk on.  However with a history of injury or in highly sedentary individuals (under-use), that timing can be altered.  Simply "pumping" the ankles throughout the day, doing a few "heel raises" in standing (i.e. raising up on your toes 3-5 times) and weight shifting back and forth prior to activity can help ready the body for action and minimize the risk of injury. For individuals who might drive a long distance and then have to step out of a vehicle.  This 30 seconds is well worth the time.

There are of course many more ways to lower injury risk at the ankle - reach out with questions.

Have a great weekend,

Mike E.

 

MOVE: 7/10/15 Heading South of the Land of Leverage - the Achy Knee

Spoiler Summary - heading south to the land of leverage....the achy knee.

After a short break last week, we're back on our journey around the functioning body.  This week, to one of the most commonly over-stressed, all-too-cranky and sometimes noisy parts of the body....the place where the tibeofemoral, the proximal tibeofibular and the patellofemoral joints all come together....the place where the ACL and PCL cross paths and the place where, if the rate of discomfort were to continue to increase at the rate it has from the 70's (up 65% from 1974 to 1994 for example) most of us will ache in retirement.....more commonly known as "The Knee".

 

The knee is another one of the marvels of the human body.  It allows us to get up, move around and walk tall.  However, with the relatively long boney levers (femur and tibia), the instability that comes with a round surface (femoral "condyles") sitting on top of a flat surface (tibial "plateau") it is inherently unstable and therefore at-risk for faulty movement.  Faulty movement that lasts long enough increases the odds of an injury and commonly grows up to become discomfort.

However there's VERY GOOD news - most of the knee pain that people experience, especially the kind that comes on without a specific traumatic event (they just begin to ache), is preventable entirely or can be corrected.  

It's in this arena that most of the effort has been placed for knee injuries.  Whether it be in athletes and attempts to reduce the rate of ACL tears, or in the more common (and sometimes obscure) "behind the kneecap" (patellofemoral) pain syndrome that so many experience, the greatest clinical impact tends to be "normalizing movement".  Even when compared to certain surgeries, when you consider the whole picture, normalizing the way the body works is best.

So what is "normalized movement"? Well....it's temping to say it should bend 130 degrees and extend fully, that's what you'd find in a textbook, but it's a bit more nuanced than that.  During every step you take the knee not only bends and straightens...it also twists slightly, moves side to side a little and the kneecap (patella) slides around a bit.  These are called accessory motions and they are critical for normal movement.  However, too much of a good thing can become a very bad thing, with these movements often becoming a source of dysfunction and eventually discomfort -- Too much motion in one (or a couple) accessory movements and things "ride" funny.  Too much motion in all areas and the entire joint may become unstable.  Too little movement because things are compressed, and things grind and wear-out faster than they should.  So...much like the rest of the body...it's a goldilocks premise:  not too little, not too much, just right.

Although it often takes a trained eye to tease out various "movement faults" and therefore suggest specific corrective strategies, here are six things anyone can do to minimize risk of injury and pain.

1. Keep your HIPS flexible and strong.  Yep....HIPS.  Although it seems to make sense that knee pain is a result of knee problem, this logic hasn't proven out in all cases.  Remember the "leverage". More commonly, hip motion (or lack of) dictates the position of the knee....and therefore how it moves.  Keeping hips flexible and strong can keep the forces on the knee more normal.

2. Keep your body weight in mind.  This one is pretty straight forward -- the more weight we are carrying, the more compression on the knees.

3. Stay hydrated.  The soft tissues between the knee and the ligaments that hold it together all rely heavily on water for health.  Without proper hydration they become more stiff than they should be and are more susceptible to injury.

4. Remember nutrition always matters. Not just from a calories or weight perspective, but also from an inflammatory one.  Certain foods contribute to inflammatory conditions and the joints are just as much at risk as other areas - gout is an excellent example (see "current understanding" here).

5. Protect your knees. Quick loading (like jumping on/off things), twisting (changing direction quickly) and high-load positions (like deep squatting) all increase risk.  Although these should probably be avoided outright in many situations, when not possible, minimize the reps or duration. 

6. Keep MOVING.  Remember, the body was built to move.  Stationary postures allow surfaces to get (relatively) dry and stiff. Consider motion breaks (i.e. "unwind" by going in the opposite direction) for 15-30 seconds here or there when you can.  If you're sitting, stand.  If you've been on your feet all day, sit.  If you're stationary, MOVE.

Of course, there are many more than we can list in one post....and we're happy to keep the conversation going.  Let us know if you have questions.

Have a great weekend,

Mike E.

ENDURE: 7/2/15 Having Freedom and Enjoying it too

Spoiler summary - 239 years ago a group of visionaries declared living in America meant living free. So what's stopping us?

I don't know about you - but I love this time of year.  My kids are home from school and aren't (yet) bouncing off the walls; the weather is hot, but not (yet) unbearable, and whether it be with the smell of BBQ, catching a summer ballgame, or enjoying some "pick-your-own", if you play it right, you can savor the moment and remember exactly how good we have it.

In truth, I sometimes wonder if everyone is as sappy as I am:  

• I get choked up when I hear Ray Charles' rendition of America the Beautiful, 
• Every single time, I watch the local fireworks wide-eyed and 
• I absolutely LOVE seeing (on twitter) and hearing (in the living room) the "USA, USA" chants when our national team - in this case Women's soccer - is showing off exactly what it means to be strong -- and the list goes on.

To be honest - I hope you are that sappy. Everyone should be that sappy when something is worth being proud of; and...even with all its warts and imperfections....our USA is.

However, I'd be lying if I said I never wondered if those same visionaries....the ones who sacrificed everything....the ones who put themselves way, way out on the limb to stand up for something bigger than themselves, could have ever predicted how few of their descendants would be able to fully enjoy the freedoms they helped put into place.

  

I wonder sometimes if 239 years ago they could have ever fathomed that more than 100 million of their compatriots would have at least 1 chronic disease; that it would account for 7 of 10 deaths and that +/- 86 cents of every healthcare dollar would be spent dealing with them.  That's not free.....and it's not freedom.  It's a modern-day oppressor, but one we should be free of.

But as you know, there's good news.....they're preventable.  The World Health Organization and other authorities point to the fact that as much as 80% of heart-disease, stroke and diabetes, as well as 40% of cancers can be prevented....avoided entirely.  It's time. 

This means, with the right dose of: MOVE, FUEL, RECOVER, ENDURE and CONNECT, the majority of Americans can enjoy freedom -- fully -- as intended:  

• The freedom to move when, where and for however long we want to.  
• The freedom to pursue our passions without the need for a handful of medications or overwhelming fatigue and
• The freedom to sit back, pain free, on the 4th of July and enjoy the amazing gift we were given 239 years ago and the gift we hope to give to the next generation(s).

On behalf of my team, we wish you a full, free and healthy Independence Day.....

Now, go do something extraordinary,

Mike Eisenhart, PT

Managing Partner, Pro-Activity