Whole-Body Alignment Program

Citation preview

Katy Bowman’s

Whole Body Alignment

Whole-Body Alignment Program

RESTORATIVE EXERCISE INSTITUTE

Developed and Written by Katy Bowman, M.S. Manual Version July 2011

Whole Body Alignment

Copyright C 2011 by Katy Bowman All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles or reviews. Restorative Exercise Inc. 5550 Telegraph Road, Suite A Ventura, CA 93001 www.restorativeexercise.com Send feedback to [email protected] Produced in the United States of America 10 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data is available for this title. ISBN Editing by Michael Curran Cover design by Carol Gravelle Artwork designed by Katy Bowman and Michael Curran and Shelah Wilgus Photos by Cecilia Ortiz or Breena Maggio all unless otherwise notated To place orders: Tel: 805-642-9900 Fax: 805-642-0081 E-mail: [email protected]

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TABLE OF CONTENTS The History of Biomechanics, Movement and Exercise

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Movement is Medicine

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The Science of Anatomy

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The Paradigm Shift: Out With Exercise, In With Natural Movement

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Biomechanics of Muscle and the Cardiovascular System

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Cardiovascular Health and Geometry

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The 25-Point Alignment Program

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The First 50 Exercises

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Trunk, Core, Pelvic Floor Physics

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Shoulder Girdle

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Foot, Lower Leg, & Gait Basics

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BoSU Protocol

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How to Design Your Program

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Becoming a Restorative Exercise SpecialistTM

104

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The History of Biomechanics, Movement, and Exercise Bio: Life; living organism Mechanics: Classical mechanics is a branch of physics concerned with mathematically describing the forces that create motion of bodies and the effect of these motions on their environment.

Biomechanics began at the beginning -- not the beginning of the century, not the start of the Christian Era, nor did it bloom from the Ancient Olympics. The movement forces began with life, as the very definition of “life” includes mechanical concepts of Work (movement): The property or quality that distinguishes living organisms from dead organisms and inanimate matter, manifested in functions such as metabolism, growth, reproduction, and response to stimuli or adaptation to the environment originating from within the organism. The written history of biomechanics is generally recognized to begin with a series of Aristotle’s essays De Motu Animalium (Movement of Animals), in which he uses the not-

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yet-termed mechanical concept of ground action force as a starting point to deliberate where movement comes from. The body? The spirit? These are good questions. Biomechanics as a United States university program began just after the First World War. The first-time widespread use of explosives in battle resulted in unprecedented numbers of amputees. These weren’t old men who could live out the rest of their lives with a peg for a leg. These men needed to start and support families, take over family businesses, and fully participate in the country they had just defended. The use of heavy explosives created a situation in which military technology had exceeded medical technology. Medicine was obliged to deal with the situation, and had to adapt. Designing a prosthetic wasn’t a medical emergency nor a chemistry problem. Doctors had to turn to mechanical engineers in the University system for help. Engineers took a look at the arm or leg from a mechanical perspective and attempted to create a replacement with as much of the same functionality of the original limb as possible. At this point, biomechanics became a university study option for mechanical engineers. In modern science where they were previously separated, this was the first marriage between the biological and physical sciences, and required a mastery of anatomy, physiology, physics, and mathematics. Exercise. As the effects of the Industrial Revolution set in, Americans became more and more sedentary, which gave rise to the concept of “exercise,” where to compensate for the decrease in regular, daily movement, we would intensely move the whole body in short bursts. Fifty years later, biological movements like walking, squatting to birth or defecate, flexing, extending, and rotating all the joints on a regular basis were decreased to the point that new generations had no handed-down knowledge of how people moved before the population had stopped moving (if you watch Disney’s WALLE, you can get a nice visual of this phenomenon). Around the 60s and 70s, programs of kinesiology (technically, the science of human movement) began appearing in university curriculum, but these programs were incorrectly named. The departments of kinesiology should have been called sport science, as the programs offered contained only those movements used in modern athletic and sport-related activities -- very different from the science of movements humans have been doing for the last 200,000 years. Biomechanical programs, following the trend of kinesiology, have since focused the bulk of their curriculum and funding to study “exercise” instead of movement, and athletics (golf, golf, golf!) instead of health. Both science and research have shown that fitness does not equal health, not in the heart and not in the joints. This is confusing to many. If the cause of most ailments affecting affluent populations -- ailments like osteoarthritis, diabetes, osteoporosis -- is lack of movement, shouldn’t exercise be the solution? The answer is, no. Exercise is not the flip side of the sedentary coin -- movement is. While the difference may seem like an argument in semantics, these two habits are quite different. Movement, specific to the requirements of biological survival, not only keeps us fit in the terms set by pop magazine culture, but also matches the mechanical requirements of human tissues. These are movements like walking long distances, squatting to bathroom and birth, hauling your weight up and over, or lowering full body weight.

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Natural motion respects tissues threshold for loads, requirements for vibration, and provides other mechanical necessities like gravity assisted functions of the internal physiology. Doing natural, reflex-driven movements from birth not only utilize the large muscle groupings we commonly thing of at the gym, but the other 500 muscles as well, including the muscles between the ribs that open and close to inflate the lungs, the intrinsic muscles of the feet that create the arch shape of the foot, or the constant forcegenerating sheets that make the pelvic floor. Exercise, while having much of what makes movement good, carries with it elements that make it far less superior, such as small quantities, high intensities, and large unnatural and repetitive forces in the joints. It is these characteristics that leaves exercise a poor substitute for movement and is why professional level athletes, weekend warriors, and gym rats do not have better health (in such terms as surgeries, medications, and death from cardiovascular disease) than those who sit and do nothing at all. Like any natural organism functioning in a natural world, balance is the key to survival. Survival of the population, survival of the individual, and survival of the cellular structures that make up said individual all depends on the delicate balance of forces within the body. Movement, when mimicking the habits of those humans long passed, provides us with the required mechanical stimulation without which we die. While we tend to think of death only in terms of the whole person, we allow small deaths like that of cartilage, bone, or parts of organs to fall under other names and categories. It does not occur to us that a lack of movement is the cause of these deaths, but blame other, uncontrollable things like age or genetics. It is very easy to understand how whole-body movement keeps our body in a state of re-generation (and not de-generation), through the application of simple geometry and physics to known processes of physiology and anatomy. Our physiology functions much like a self winding clock. Actually, we are comprised of 600+ self winding clocks, for each muscle has its own responsibility to feed itself. The “original blueprints” for the human, no matter the source, surely couldn’t have accounted for a time when bodyowners would spend so much time spent ignoring biological signals of stress, hunger, and fatigue; the owner of a human-machine would render itself inert by choice first, and then eventually by habit. Since Aristotle and Newton, we as a population have become less concerned with our understanding of the laws of nature and natural movement and more familiar with cardio machines, hand weights, and high-tech footwear. Movement has been a void in our lives for so long, that to become moving creatures (as opposed to exercising ones) seems impossible. Rearranging our lives to accommodate less -- less work, less stress, less furniture, less driving, less sitting, less convenience -- seems too much to ask... at first. This platform, that you are about to study, is the content of the ever-elusive human manual. A guide to the nuts and bolts of the biological machinery under the influence of mechanics, this book shall first be a service to one’s self. Before taking this course as a practitioner, you must first take this course for yourself. Get to know yourself and then

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spend the rest of your life mastering yourself. If there is time, you can work on yourself with others, allowing them to learn via your example. In both Aristotle’s writings and Isaac Newton’s equations, full stability (a fixed point at each joint) gives a human being the ability to live using every single one of their muscles -- all 600 of them. But the lack of moving for years (or, as a population, for a few hundred years) has left us overusing a few joints, while the rest of the body sits dormant and inert. Leonardo da Vinci would likely say that the result would be decreased output and function of the machinery. Cells would die. Disease would ensue. Aristotle would say that, under sub-optimal conditions, one’s spirit and life force would be unable to express. Both would probably be correct. There is a solution. Freedom from disease is attainable, by using the whole body in a biological, reflex-driven way. First, we must be careful not to force the concept of movement into an inaccurate paradigm To isolate parts of the body when strengthening or to think of strength as something any less than a whole-body event is to miss the point. You were designed to be a strong-yet-supple dynamic creature of endurance. Its time to start acting like one.

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Movement is Medicine “The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease. Thomas A. Edison, US inventor (1847 - 1931) -

Natural Movement Approximately 10,000 years ago, mankind embarked on a new frontier: farming. This change from a long-distance roaming culture to an agricultural one has also become a tick on our human timeline, marking the greatest catalyst for the rise of affluent disease. These diseases of affluence -- osteoarthritis, type 2 diabetes, coronary heart disease, low bone density, pelvic floor disorders, obesity, asthma, allergies, chronic pain, fibromyalgia, and many more -- all share a common root in our lack of movement as a species. Billions of dollars spent in researching solutions, pharmaceuticals, and discrete causation have done little to affect the growing numbers of diseases across the board. The prevailing medical solutions, ranging from drugs to low-fat diets to health-club style exercise programs, are not reducing the number of people suffering with these diseases. So what’s going on here? When you look at the timeline of human evolution, 10,000 years is surprisingly little time in terms of our biological make-up. Recently, researchers of the Paleolithic diet were

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able to establish one broad factor in modern diseases -- eating anything not available during the development of our current genome is metabolized with great penalty. So, processed foods out, natural foods in. Simple. If we take the simple-yet-brilliant theory -- there is a “correct” way to use the body -- and apply it not just to what we eat but also to how we move, BAM!, you’ve got yourself another, simple-yet-profound solution. When it comes to movement, the answer to getting your body to move and feel well is along the same line as the paleo Diet. The types of movements that were utilized while our genome was developing included massive amounts of walking, squatting, and just regular use of all your bending, twisting parts, making these movement qualities (and quantities) a requirement for optimal function of the human machinery. The American Journal of Medicine released in 2010 a new position on solutions to endemic, chronic ailments for which medicine provides no cure. While not the magic bullet that most sick Americans might wish for, it is still a magic bullet: The systematic displacement from a very physically active lifestyle in our natural outdoor environment to a sedentary, indoor lifestyle is at the root of many of the ubiquitous chronic diseases that are endemic in our culture. The intuitive solution is to simulate the indigenous human activity pattern to the extent that this is possible and practically achievable. These are a lot of fancy words that say: you, who sit at a desk inside your office all day, get to most places riding inside your car, have worn shoes all of your life, and have done your exercise on the machines inside the gym, are most likely going to suffer from an “affluent disease.” What would natural movement even look like? First of all, gone are the days when 30 to 45 minutes of exercise was “good enough.” Ninety minutes per day seems to be the minimum to even come close metabolically to the 800 miles a year walked by average Paleo women, while carrying their children. And dispersing that mileage evenly over 365 days a year doesn’t equal the hunter-gathering habit either. Your new habits should include walking longer bouts, of up to 10 miles, followed by days of rest and shorter distances, until the next long trek. And, after they’d have walked (and walked and walked), the movement of huntergathers would have looked something like a natural version of cross-training, interspersing lower intensity movements with random peaks in intensity -- like trying to climb a tree every now and then, squat to use the bathroom, and quickly build a shelter a la Nanook of the North. High-intensity cardiovascular activities are out on the hunter-gathering plan. Hooray! Long-distance running and machine-based activities (cycling and treadmills) do not use natural movements. The hunting-gathering prescription finally fits what cardiovascular research keeps showing in study after study -- that exercise does not need to be intense in order to strengthen your heart and lungs. P.S. No long-term or well-designed study has ever shown cardio-vascular exercise reduces death from cardiovascular disease. 10

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That surprises you, doesn’t it? Well, it’s true, and well-documented in the literature, yet intensity in exercise as a healthy-heart requirement has been perpetuated by the fitness and health magazines ad nauseam. Jogging and running are out and walking is in. Speaking of walking... Physicists have been stating this about human locomotion for some time now: Physicist: Hey, you... Yeah you. You know what you’re doing right now? Nope, that’s not walking. What you have there is falling. Ninety percent falling. Which means that not only are you barely expending any of your own energy on that hour-long “walk,” but with every step you are landing -- full body weight -- on those poor little feet, knees, and hip joints. Good luck with sustaining that. In addition to increasing how much we walk, there is also the need to overhaul how we locomote from point A to point B. Although extremely well-trained in chemistry, exercise physiology, and perhaps even medicine, researchers typically lack basic training in the laws of Newtonian physics, Euclidian geometry, and engineering that make it possible to see the blueprint of optimal human movement. This blueprint helps a biomechanist like me create the rules of walking. Following these rules will help ensure that your muscles and joints are better equipped to minimize incorrect movement patterns and maximize muscle use and even better yet, the caloric expenditure of each walk. Aligning our alignment According to the medical journal article cited above, the key to disease prevention “is to simulate the indigenous human activity pattern to the extent that this is possible and practically achievable.” In modern times, we have many habits that have not only reduced our total movement, but to a greater extent, have affected how we move when we do move. It is this subtle and generally overlooked fact that has left world-class athletes with joint replacements before turning 40. It has left daily exercisers and organic eaters with the same chronic ailments as soda-guzzling couch potatoes. And it has left you, dear reader, confused about why, after following all the recommended guidelines for health, you are still hurting, somewhere in your body. So, what did this paleolithic person do (or not do) that gave them a better-developed structure as compared to us with all our modern wonders? They did not wear shoes.

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Did you know that 25% of the number of bones and skeletal muscles in the body reside from the ankle down? Did you know that the average person can no longer move their toes individually and contract their arches at will? They dropped down into a full joint-flexing squat a few times per day to bathroom. This is not only an issue of muscle tone, but of joint lubrication, lymph, blood, digestive and neurological flow. Unlike us, they did not sit in the same position (think of your chair) every day, eight hours a day (or more), since age five. Also, they birthed their children in a squat position, increasing birthing space and speed of labor. They walked with natural, reflex-driven arm swing. Many fitness-walkers pump their arms and fists out in front of them, sometimes even using weights to generate more resistance. Then, most all of us hold our arms out in front of us (think driving or computering) for over 8 hours a day. Our paleo ancestor wasn’t doing any of these things. They rested, often. Of course, lack of movement is a risk factor for disease, but so is daily exercise without proper physiological rest, sleep, and moderated stress levels. These are just a few of the differences between us and the paleo-peoples, but from a biomechanical perspective, a lifetime of these habits leaves the average human using no more than 25 percent of her total body musculature. This is a big deal! Even if you did want to start beefing up your movement program, you would just be taking your lowmotion, 25-percent-of-muscle-using body greater distances, which is a major contributor to joint ailments like osteoarthritis. Twenty-five percent of muscle use means 75 percent of the bodies tissues are struggling to survive. What most people don’t realize is that the contracting and relaxing of skeletal muscles is what drives blood into the body’s remotest capillaries. In other words, if muscles in a part of the body are not doing any work, that part of the body will become undernourished, and jammed with stagnant waste. So the problem is not just how much we move, and it’s not just what movements we’re leaving out -- the problem also includes how we move when we do move. The movement patterns of most modern peoples have systematically reduced the number of active parts of their body, resulting in organs (pancreas) and joints (hips and knees) that waste away under the waste accumulation, and lack of cellular restoration. And that’s not good. The good news is that this is all fixable, by restoring our movement patterns back to those we were designed to use -- those patterns that we have within our genome. There are modifications you can make to your modern-world reality (consider a standing work station) that can positively impact your health, without requiring any additional investment of time.

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Restoring a natural walking pattern would increase muscle use while walking, decrease joint degeneration, and actually promote restoration. And you should know, your metabolism is based on how much muscle you are using. Without alignment, it is impossible to be meeting maximum metabolism potential. Moving like a hunter-gatherer usually starts with an easy exercise program overhaul. Most people find it easier than what they were struggling to do before. As headlines on both CNN and Newsweek recently stated: “Exercise won’t save you.” Natural alignment is something that needs to be restored every day, throughout the day, for whole-body well being. These are the most basic components of hunter-gatherer movement that should be considered when attempting a lifestyle program for optimal human function: • People should be walking from the earliest age possible, which means children need to learn how to walk along with a group of people and be given adequate training time to do so. • Footwear affects every portion of human movement and should be reduced to styles that provide the most protection with the least amount of structural influence. • Movement needs to happen throughout the day, and not in one single bout. Suggestions for hunter-gathering habits for office-working humans will include easy-todo walking programs that work within their normal schedule. • Those on the computer need to create a standing work station to allow lower body muscles to participate in circulatory duties. Sitting time is the greatest predictor of death even in regular exercisers! • Regular squats need to be incorporated into daily movements for the purpose of hip, knee, and pelvic floor health. The squat is a critical muscle toner of the posterior walking muscles. Millions of modern humans, are spending billions of dollars trying to do one thing: Feel better. As stated more clearly than ever before by the medical community’s own journal, the solution to chronic pain and disease is in “realigning our daily physical activities with the archetype that is encoded within our genome.” Indeed. References Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116:1081-1093. Johnson JL, Slentz CA, Houmard JA, et al. Exercise training amount and intensity effects on metabolic syndrome (from Studies of a Targeted Risk Reduction Intervention through Defined Exercise). Am J Cardiol. 2007;100:1759-1766.33. Goel R, Majeed F, Vogel R, et al. Exercise-induced hypertension, endothelial dysfunction, and coronary artery disease in a marathon runner. Am J Cardiol. 2007; 99:743-744. Fortescue EB, Shin AY, Greenes DS, et al. Cardiac troponin increases among runners in the Boston Marathon. Ann Emerg Med. 2007;49: 137-143, 143.e1.

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Hubble KM, Fatovich DM, Grasko JM, Vasikaran SD. Cardiac troponin increases among marathon runners in the Perth Marathon: the Troponin in Marathons (TRIM) study. Med J Aust. 2009;190:91-93. Jassal DS, Moffat D, Krahn J, et al. Cardiac injury markers in non-elite marathon runners. Int J Sports Med. 2009;30:75-79. Middleton N, Shave R, George K, et al. Altered left ventricular diastolic filling following a marathon is a reproducible phenomenon. Int J Cardiol. 2007;122:87-89. Achieving Hunter-gatherer Fitness in the 21st Century: Back to the Future James H. O’Keefe, MD,a Robert Vogel, MD,b Carl J. Lavie, MD,c Loren Cordain, PhDd; Mid America Heart Institute/University of Missouri-Kansas City, Kansas City; University of Maryland, College Park; Cochsner Clinic, Jefferson, La; Colorado State University, Fort Collins.

Review Questions: 1.! What is the study of biomechanics? 2.! What are the three substances that need to circulate through the body for optimal health? 3.! What is optimal health? 4.! What role does skeletal muscle play in the body? 5.! How does alignment affect skeletal muscle? 6.! What is the "perfect length" for skeletal muscle?! 7.! What is an EMG? 8.! What makes muscle move? 9.! How does skeletal muscle movement increase local tissue health, specifically? 10. What is vasodilation? 11.! What do cells need to "feed"? 12.! What are the Fitness categories of exercise? 13.! How else can we categorize movement prescription? 14.! What is the difference between fitness and health? 15.! What is the difference between exercise and movement? 16.! How would you describe Natural Movement? 17.! Where has natural movement gone? 18.! What is a stress riser? 19.! Which direction does skeletal muscle contract?

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The Science of Anatomy “No citizen has a right to be an amateur in the matter of physical training…what a disgrace it is for a man to grow old without ever seeing the beauty and strength of which his body is capable.” -Socrates, philosopher (c.469BC - 400BC)

Anatomy is a fascinating and complex science. One’s whole life could be spent studying the the cells, tissues, and systems of the human body without ever getting to the end. The use of classification systems in modern biological sciences is also practiced in the sciences of anatomy and physiology. While classification systems are a great way to organize plants and body parts for scientific study, a classification system itself is highly culturally influenced, and can limit a full study of the tissues in question.

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For example, the current classification of plants in Western biological science is very much a visual-based system. How the plants look (does this plant flower, or not, does this plant have one seed leaf, or two) is the primary tool for botanists. This way of classification speaks volumes about a culture. Other cultures, especially those who have used plants as a base for medicines for thousands of years, classify based on function, such as the grouping together of plants with numbing extracts, or antiinflammatory chemicals, or heating properties, for example. Western anatomy has a classification system as well, and as this system was created by the same cultural group, tissues also were classified based on appearance. How tissues look is a great way to classify when you are using this system to do more looking. It makes sense. However, when it comes to function, it might make more sense to classify them in some other way. There are other cultures who have classified tissues similar to the plant methods used by Native Americans. Neither classification system is wrong. Classification is simply the naming of buckets and the placement of words into these buckets. Classification does not change the function of the tissue, but, perhaps, it can affect how we go searching for answers, when it comes to disease. Of all the “ideas” placed on anatomy, none has done greater disservice than the origin-insertion model of skeletal muscles. Taught throughout the world, the notion that one attachment point differs at all from the other has resulted in an entire world understanding 1/2 of muscular system capabilities. Just as a linguist could determine characteristics about a culture that had no word for “time,” the origin-to-insertion model of muscle actions speak volumes of a culture that sees in terms of pulling inward. The fact of the matter is, muscle always contracts end to end, or attachment to attachment. Every scientist (and any person who ever studied muscle anatomy and physiology) knows that the ends of the sarcomeres move evenly toward (concentric) or away (eccentric) from each other during muscle action. It is strange then, that we ended up with the “insertion always moves toward the origin” model of muscle contraction when muscles and actions were being paired up back in the early anatomy days. To clarify in pictures, muscle contraction neither looks like this:

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In fact, the naming of attachment points “origin” and “insertion” is part of the cultural classification problem. To avoid confusion, and to start to prepare your mind to double your knowledge of muscle actions, you will always hear me refer to muscle attachment points as just that - attachment points. The bony skeleton, while bursting with life at the cellular level, is inert in the sense that it cannot move itself. The notion that the very tissue we depend on for movement and structural integrity is unable to move or stabilize itself implies a much greater structural system that is responsible for the skeleton’s every motion and degree of stability. The musculoskeletal system is designed not only to bring the world closer to the human, but is also designed to pull the skeleton outward, and away from its center. Imagine twenty third graders standing around a parachute tarp in elementary school, each doing equal amounts of pulling outward. This outward action results in an elevation and smoothing of the inert material. In the exact same way, the 600+ muscles in the human body, when working OPPOSITE to how we have learned muscle motion academically, stabilizes the human body evenly, increases joint space, and allows for the possibility of controlled motion in any direction. Tissue classification: Muscle The term muscle tends in evoke images of movement. Derived from the latin word muscolis, or small mouse, early anatomists termed the tissue after anatomists saw it quivering under the skin like a mouse. As the science of anatomy progressed, other anatomists delved under the skin, and found other tissues with similar contractile properties. From that point, muscle became a category for three tissues: •

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•

Cardiac muscle

•

Smooth muscle

Cells that made up these these tissues were considered unique for their specialized ability to contract as well as conduct electricity. Anatomists and physiologists, after further study, classified each muscle tissue into two categories -- voluntary and involuntary, as noted below: •

Skeletal muscle - Voluntary

•

Cardiac muscle - Involuntary

•

Smooth muscle - Involuntary

Just like the origin-insertion model of muscle action, this classification of muscle also is not 100% accurate, as there are other tissues that generate force or have movement. These tissues (for example the tail of a sperm that spins to propel the main body, or the hairs that move in your sinuses to expel foreign bodies) should -- in a function-based classification system, belong with muscle. In our Western system, we leave these out as these cells look different than the cells making up “muscle.” Also, the terms voluntary and involuntary are misleading, as there have been many studies on many people who can control supposedly involuntary actions through bouts of meditation or great practice in body control. Perhaps involuntary and voluntary should be further explained to be default settings, and not a description of capability. The musculoskeletal system Human life begins with movement. Even before your first twitch en utero, there was the contraction of your mother’s uterus, placing her ovum (the egg that was to become YOU) just so. Simultaneously, the specialized, force generating tail (flagellum) of a sperm cell propelled it towards the perfectly placed egg. Movement is absolutely essential to the continuation of life, and human tissue would soon die without musculoskeletal activity. It is probably easy to understand that those who move tend to have better health than those who don’t, but the role of skeletal muscle in disease prevention goes much, much deeper than the oversimplified and oft-reported benefits of regular exercise. What is it about movement that maintains health? The role of the musculoskeletal system has been, in the sciences of medicine, anatomy, and physiology, been isolated to that of large-scale movements, like moving limbs for walking, playing sports, etc. While this role is certainly important, it is merely a fraction of what the muscular system can do. Looking more closely at what happens when a muscle contracts around fluid filled sacks like abdominal viscera, or how skeletal muscle stimulates a motor response in smooth muscle is truly where mastery of the field of biomechanics reveals hidden answers.

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Although they are not so classified, skeletal muscles are involved in every other system’s function of the body, including, but not limited to: •

Respiratory

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Digestion

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Cardiovascular

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Lymphatic

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Reproduction

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Neurological

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The Paradigm Shift: Out With Exercise, In With Natural Movement

“All great truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” — Arthur Schopenhauer, philosopher (1788 - 1860)

As laid out, moving in ways that match our current human genome gives our tissues the correct amounts of stimulation. In biology, more is not better; it’s just more. In fact, in biology “more” usually has negative biological consequences. With an overload to the system (too much intensity, too much mass, too much impact) comes damage. The loads in our current model of exercise have inherent properties that actually decrease health in the long term while improving diagnostic numbers in the short term. Returning to natural movement is the way to have both good health numbers now as well as minimizing future taxes to the body.

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The ability to return to natural movement isn’t easy. Years of under-utilizing muscle and over-utilizing joints has required tissue to adapt, reorganizing cellular structure at the level of the sarcomere. With this lack of use, neurological tissue has suffered. As with a car engine, regular usage of motor units (muscle tissue and the nerves serving them) keeps all the tissues involved healthy. Conversely, the nerves serving unused muscles have decreased cellular regeneration and therefore less than optimal function. Lack of muscle use is a cycle that takes time to reverse. But reverse it can. Setting a goal for optimizing tissue health (much different than simply avoiding disease) will result in a much higher level of wellness. This level of optimization calls for a shift in the exercise paradigm. The traditional, or most accepted version of exercises typically includes three categories: Cardiovascular Exercise •

Increasing “strength” of heart

•

Increasing vascular tissue (capillary) to working tissues

Strength/Resistance Exercise •

Maintain muscle tissue for BMR (basal metabolic rate)

•

Maintain Bone density

•

Maintain function

Flexibility •

Maintain joint range of motion for ease of functional movement

These categories make sense, but are often prescribed poorly. A slight adjustment to the grouping would yield a greater benefit to health variables as well as decrease any negative consequence a bout of exercise would create. The categorization of exercise implies that the heart is not related to the muscles and that neither heart nor muscle health depends of flexibility. The notion that muscle training is somehow a separate activity from cardiovascular health training really makes no sense, but that’s how it’s perceived. This categorization ignores everything that is known in basic anatomy and physiology text books, yet is perpetuated (even in academic communities) via pop culture and a failure to follow scientific method. A better, more whole-body (holistic) way to think of motion is for all systems -- heart, muscle, and joint -- to be working together at every moment. If stretching a muscle increases its force output, how could stretching not be part of a strengthening plan? If the nerves, stimulating a muscle to contract, depend on that contraction to stay fully regenerated, how can regular muscle use not be part of a neurology-enhancing program? To optimize health, you would do best to restore correct joint mobility (which requires correct muscle length), learn a gait pattern that utilizes every muscle possible, and then

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use that gait pattern while walking for an extended portion of every day; and you can leave behind those late evenings sweating it out at the gym. Benefits of improving your alignment •

Increases in number and frequency of innervated muscle

•

Increases the number of capillaries to that muscle

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Lowers blood pressure

•

Increases the amount of oxygen to the tissue

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Improves cellular regeneration of that area

•

Increases total metabolic activity while at rest

•

Increases metabolism (BMR)

In the paleolithic days, natural movement also contained many motions that required a strength-to-weight ration of one-to-one. Not being able to stand on one leg indicates that the muscle groups on one leg are not strong enough to hold up your body while walking. Dropping down into a full squat without falling, and being able to stand up for a squat without needing to torque joints (thrust or lean forward) demonstrates that the posterior muscle group is strong enough to lift one body weight up and away from the ground. A pull up is an example of your shoulder girdle and trunk generating enough force to pull one body weight up away from the ground. Whole Body Movement Alignment is only a part of the solution, and one that is much more glamorous than the rest of the natural movement solution. The fact of the matter is, you are walking much less than your human machine requires to thrive, per day and per year. The quantity of movement is not natural if it is done in a hurried manner -- all at once or at a particular speed. Walking is simply the best whole-body exercise for health. Fully weight bearing (for bone density) and muscle using (when using an aligned gait pattern), walking creates a flurry of biological activity that is easy-yet-stimulating on the joints. It is the perfectly balanced exercise especially when doing it in alignment. Because joints that are mal-aligned have high inappropriate forces, it is not a good idea to log large quantities of miles until you have been working on your alignment points for some time. This is not to say that you should wait to walk until you have mastered the points (that will take a very long time, and walking has so many good things about it!), but you should consider the few points that give you the most trouble and perhaps work on those while walking. Once muscle length has improved, the quantity of symmetrical walking should be high and done throughout the day. And when you are finished moving, it is important to resist

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Whole Body Alignment

the urge to sit in a chair. Follow up a days worth of whole body movement with any “unchair” like motion you prefer. Research anthropologist Gordon W. Hewes spent years abroad categorizing the resting postures of various cultures around the world. This image, taken from his paper, shows just a smattering of the resting options that utilize joints in a unique way.

Pick one a day to practice. Remember, the ability to achieve numerous positions while resting is important! Maybe even create one of your own!

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Biomechanics of Muscle and the Cardiovascular System

“Do not believe in anything simply because you have heard it. Do not believe in anything simply because it is spoken and rumored by many. Do not believe in anything simply because it is found written in your religious books. Do not believe in anything merely on the authority of your teachers and elders. Do not believe in traditions because they have been handed down for many generations. But after observation and analysis, when you find that anything agrees with reason and is conducive to the good and benefit of one and all, then accept it and live up to it.” - Gautama Buddha, meditation teacher (c. 563 BCE - 483 BCE)

Muscle and the circulatory system If you were to ask many people to prioritize their health in terms of systems or parts, “cardiovascular” (CV) is always at the top of the list. This is ironic, in part, as most people aren’t aware of what the cardiovascular system does -- just the fact that when the CV system stops doing what it’s supposed to, they’re dead. In fact, preventing or treating CV disease risk factors may be the single greatest reason people exercise for health*.

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Whole Body Alignment

What does the CV system do? 1. It is an oxygen-delivery system with tubes (i.e. delivery portals) passing through every ounce of your tissue. The most valuable biological commodity to your human machine is oxygen. Your entire respiratory system is not about taking breath into the mouth -- that is only where it starts -- but about taking that oxygen and delivering it to every square inch of your body. It is common to picture the CV system like the illustration below; fat tubes taking blood via artery to the main areas of the body.

The reality, however, is far more fascinating. The main arteries of the CV system branch off into smaller tubes (arterioles) that branch off into even smaller vessels (capillaries). This tubular system makes up the three-dimensional bulk of your body. Though categorized as separate structures, it is important to remember that these blood vessels are imbedded within your muscle tissue. The main arterial system is a path - similar to main interstate highway - that connects smaller areas, but doesn’t have a direct route into very many areas at all. If you wanted to actually get out of your car and visit your in-laws, you would have to get off the interstate highway, probably onto a freeway, before finally popping out on a surface road where you could get to yourself to your destination. In this scenario, red blood cells are the car, and you are the oxygen that got delivered. Blood cells circulating through the arteries are like cars stuck in a traffic jam. Lots of people going, but no one really getting anywhere. This is why it is important for arteries to have branches - to help direct traffic towards where it wants to go, the destination tissues.

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Even in the branches off the artery (the arterioles) the cars are still packed together, only less so. At this point, the oxygen is heading in the right direction, toward the tissue, where it finally comes to the capillary. Capillary vessels are extremely thin. They have walls that are only one cell thick, so this is where the blood cell can deliver its oxygen. In order to deliver the oxygen across the cellular barrier, blood cells need to go through one at a time. If they weren’t in a single file line, there would be no opportunity for the middle blood cells (those surrounded) to give their oxygen. That would be a waste of energy, so your body doesn’t do it that way. Blood cells always go single file through the capillary.

Channels that transport oxygen to tissues (red circles portray red blood cells)

2. The flow of blood serves as the driving force behind waste removal across the capillary bed. The thin walls of the capillaries are where diffusion (the moving out or moving in of “stuff”) happens. Capillaries not only deliver oxygen across the thin barrier, but also are the site of cellular waste to leave the blood stream and be evacuated. The less blood moves through a particular area’s capillaries, the poorer the oxygen delivery and the waste removal. Most people (probably anyone you asked) would say that the heart provides the mechanical energy needed to move blood through this intricate tubing. And this is how most people are using their heart. If you are using your heart to push the blood through your body in order to deliver oxygen, then you would want a heart that is extremely strong. It makes sense. There is, however, another way to get flow without putting so much burden on the cardiac muscle. 26

Whole Body Alignment

The Lymph System Lymph is the fluid carried by the tubes of the lymph system and processed in the lymph nodes. What was once blood plasma becomes lymph once blood passes through the capillary system. The high pressure arterial system forces the fluid and small-particle waster through the thin walls of the capillaries where it is taken up by one-way valves in the capillary-sized lymph collection tubes. These smaller tubes meet up with the large tubes that take the lymph (essentially the waste product of the oxygen delivery system) to the lymph nodes. Lymph nodes, manufacturing white blood cells, treat this fluid for any bacteria. When bacteria is present, the nodes swell with the increase of white blood cells. After being treated, this fluid moves back to the end of the venous system, dumping back into the circulatory system at a thoracic duct near the left subclavian vein, where it becomes blood plasma again. Other roles of lymph: lymph formed in the small intestine is called chyle. Chyle is the same interstitial fluid infused with the fats absorbed via the intestines. It is through the lymph system that fat is delivered to all areas of the body (the wall of every cell in your body is made of fat) for cellular regeneration. Why is alignment important to the lymph system? The lymphatic system is without a large pumping mechanism (like the heart) and is designed to piggy-back on the musculoskeletal system. The greater the whole-body muscle innervation, the greater quantity of blood cleansed by lymph and the greater the cellular fat distribution. Large lymph node clusters are located in the neck, armpits, deep hip (groin), behind the knees (popliteal), chest, and abdomen. How convenient! Just moving keeps us healthy-the more we move, the more we clean our blood. So what happens in the case of knees, hips, and shoulders that don’t change position? The lack of movement in our major joints is major interference to our natural immunity. Alignment matters, for sure! The walls of the venous (vein) and arterial (artery) system contains smooth muscle. Smooth muscle, like cardiac and skeletal, has the ability to change lengths. Because smooth muscle forms a tube in the case of arteries and veins, a change in muscle length also means a change in tube diameter. Blood vessel tubes stay constantly contracted (called vasoconstriction) in unused muscles. This smaller tubing reduces the volume of blood allowed into an arteriole and 27

Whole Body Alignment

therefore the capillaries. Relaxed smooth muscle (called vasodilation) increases the diameter and the flow into the artery, allowing more blood (and therefore more oxygen) into the arteriole, capillary, and finally, into the tissue.

Each muscular innervation provides mechanical stimulation to the smooth muscles walls of the arterioles within that muscle’s body. This signals the tubes to relax and open (vasodilate). This opening creates a pressure gradient (drops the pressure in the arteriole and capillaries) that pulls blood toward the area. reducing the resistance normally working in opposition to blood flow. The current rationale of heart-strengthening (i.e. cardiovascular) exercise is to improve the heart’s ability to circulate blood. But most people have large volumes of underused muscle. And the blood vessels in these areas are resisting every bit of work the heart does to attempt to circulate. It is much safer for the vessels of your cardiovascular system to open in order to increase blood flow, as opposed to increasing the cardiac output (how much blood your heart ejects with each pump) against unyielding smooth muscle.

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Cross section of a Skeletal Muscle

Why is alignment important? Now that you have begin to understand how the innervation of muscle affects circulation, the next step would be to understand how muscle position affects force generation. The skeletal muscle itself is made up of smaller contractile units called a sarcomeres. The sarcomere is a simple unit of tissue that is able to shorten itself and then release back to its original length. A muscle is essentially a bundle of many fibers and these fibers are simply a long chain of sarcomeres. What a muscle does (shortens, relaxes, or lengthens) is simply what the sarcomeres are all doing. When the sarcomeres contract, the entire muscle contracts. When sarcomeres don’t budge, neither does the sarcomere. In this way, the muscles are simply an indicator of what is happening on the smaller scale. Because force generation in required both for large scale movement (like walking around) as well as the movement of the individual oxygens being transported on red blood cells, it is important to figure out -- how can I optimize force generation? Every human has equal ability to generate the same amount of force relative to muscle mass. The hardware -- nerves, proteins, muscle fibers -- are similar stuff in every human. What makes us end up producing different quantities of force comes back to what is happening at the level of the sarcomere. The movement of a sarcomere (and therefore a muscle) is created by the movement of actin protein on the myosin protein. The amount of force produced when a muscle (bundled chains of sarcomeres) innervates depends on how many bonds are able to form and the angle at which the bonds occur (along the moment arm). The greatest amount of bonding happens at a mid-range, where the sarcomere is neither too short nor too long, and the bonding angles have better biomechanical advantage (also know as leverage).

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Finding the exact position for each sarcomere is nearly impossible and fairly impractical. However, a force-length graph based on actual data collection shows that the maximum force productions are created when a muscle is towards the longer rather than shorter lengths. Joint position is the easiest way to determine muscle length. Using cadaver-collected joint ranges as a benchmark, there are muscle lengths that are required for joints to function according to their design. Joints that do not have their full range of motion have muscle tissue that is not at its force-maximizing lengths. Using joint position to measure muscle length is a qualitative method to quantify potential force. Tight muscles have low sarcomere protein bonding at low angles and look like this:

Sarcomeres that are on the long side are also low-force generating. This population will have instability around large joints and inability to maintain desired skeletal position. There is also low sarcomere protein bonding at a high angle. Theses sarcomeres look like this:

These populations will present with unique looking frames and movement patterns but the problem is the same: non-optimal position of the sarcomere. In the ideal arrangement, both the overlap and the angle are optimal for generating force. This sarcomere position looks like this:

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Whole Body Alignment

Because each muscle differs in length, it is impossible to generalize the length in terms of units. Relatively speaking, the force-length graph looks like this:

Maximal force generation is when muscles are on the longer side of average. It should not be surprising that the optimal length of a muscle is also the length that provides the greatest amount of joint stability while also offering the greatest amount of movement. We could call that natural balance. It is from this standpoint that Restorative Exercise’s guidelines for alignment and human movement were created. The 25 points of alignment are objective markers (bony protrusions in most cases) that can serve as a good landmark for where the muscles are, and in what planes of motion you habitually use them. Knowing basic properties about muscle physiology and biomechanics, it is very easy to change these bony landmarks around until some elements (like force production) are optimized and other elements (like friction) are minimized. The 25 points are user-guidelines for mechanical function to help troubleshoot injury or prevent ailments from occurring. Although fairly rudimentary of a system -- 25 points on a body with over a billion cells is a drop in the bucket -- our current culture is so out of alignment with nature, these 25 points are revolutionary in their ability to mitigate biological injury.

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Muscle innervation The amount of force resulting from muscle innervation can be measured in two ways. One is to measure the peak force, or maximum force in a moment of time. The other is to measure the sum total of lower but constant forces exerted over time. Lifting something heavy one time will result in a peak force -- and this force has a quantity of electricity that is associated with it. The constant use of lower-level forces (e.g. all-over muscle contraction in aligned standing as opposed to slouching and resting on non-contractile connective tissue) gives us a lower peak force, but a higher amount of total force over time. If we were to measure health in terms of amount of oxygen delivered, then we would want constant innervation (easier to sustain with less muscle damage) of the skeletal muscle in order to continue dilation of the intra-muscular smooth muscle, to optimize oxygen delivery. This endurance type of muscle innervation (the sum of lower peak forces over time) is what “greatest amount of force” will imply in the context of this course.

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Cardiovascular Health and Geometry

He who has health has hope; and he who has hope has everything. - Arabic Proverb

Hemodynamics (hemo: relating to blood or blood vessels; dynamics: mechanics, “the time evolution of physical processes”) is the study of or the principles that dictate how blood moves through the body. Haemodynamics is similar to hydrodynamics (the principles that dictates how water moves), only different. The main difference is that water is a Newtonian fluid – meaning that all parts of water are doing the same thing at any time. Blood is a non-Newtonian fluid, meaning different parts of blood do different things. This is because blood is made up of blood cells floating in liquid. The cells have a rigid shape (well, rigid for cells) while the blood plasma is more fluid. A main contributor to cardiovascular disease is plaque accumulation. While it seems that plaque is a negative, plaque actually acts as a “scab” and is the natural part of healing -- like a tissue reinforcer -- until the area is no longer being damaged.

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There seem to be two situations that increase arterial plaque -- inflammation and wall wounding, or the bouncing and scraping of cells against the thin, inner-most layer of arterial cells. The cause of chronic inflammation is unclear, although it tends to go hand in hand with poor nutrition and high levels of stress. It is unclear if the inflammation is a separate event from the wounding or part of the cycle. Although both pop-health publications and allopathic medicine often focus on high cholesterol as the cause of plaque, there is actually no research that demonstrates any such causality. Because plaque accumulates not because of blood chemistry, but because of the interaction between tissues (walls and cells) it is important to be aware of how body position, exercise intensities, and other habits increase the risk for wall wounding. What causes the blood cells to smack into the walls of your blood vessels? 1. Blood vessel geometry. The good news: Your arteries, where they are located and how they branch off, are arranged in a very specific way to maximize pressure gradients and keep flow smooth. The bad news: Your artery geometry changes with your posture. Adding twists and turns in the arteries by chronically bending joints for excessive bouts of time every day is like adding curves in your hallway. Rolling balls are guaranteed to smack into the curved walls in your home just as blood cells will run into the curves of the vessels -- every time. This is why research shows that exercise doesn’t offset the effects of sitting. You can’t undo eight hours of wounding with a run or with bigger muscles. Fitness doesn’t touch the wound that has been created. What affects blood vessel geometry? There are natural changes in BVG in the body, where arteries branch off to travel different directions. In these places, the arterial walls have programs to deal with the change. The real issue is the change to your blood vessel geometry that happens when you adopt chronic postures. 2.The type of blood flow you are creating. Blood flow can be turbulent (like turbulent air during a flight) or laminar, which is all of the blood smoothly flowing in the same direction. Turbulent flow can take a blood cell and, instead of letting it flow straight through a vessel, can slam it up or down, into the wall. BAM! Wall wound.

We want to avoid turbulent flow because this type of current takes the blood cells and accelerates them into the walls (BAM!), creating a wounding that begins a cycle of inflammation, scabbing using cholesterol and calcium (which contribute to the hardening 34

Whole Body Alignment

of the artery), which then begets more turbulent flow (and more wounding, and so on and so on.) What causes turbulent flow? Picture a tube, like your garden hose for example. You are probably well aware that you can change the velocity (the speed and direction it shoots out) of the water by changing the size of the tube, i.e. putting your finger over the end. When you are washing your car (I hope there are still people out there washing their own cars in the driveway) and want the water to shoot harder and wider to get the soap off, you instinctively know to put your fingers in a way that reduces the area and increases the velocity. Got it? This is a basic principle of hydrodynamics. Reducing the area of flow increases or changes the velocity. Within the the arteries, non-laminar flow results in blood flowing all different directions. Patches of turbulence create “walls” that are similar to your finger over the opening of the hose. Even though water is a fluid, it can still act kind of like a solid in that it can change the direction of other fluids hitting it. Once flow gets a bit bumpy it creates more and more turbulence, which in the long term creates plaque. The plaque itself is like a permanent finger over the hose so you get chronic turbulence wherever this plaque is located. Of course this begets more plaque. Any unnatural change to blood vessel size will impact the flow by changing the velocity (rate of flow or direction) of the blood. What can cause the size of the blood vessel to change unnaturally? 1. Smoking. Smoking causes an instantaneous reaction of stress chemicals (because you are basically preventing your lungs from getting any oxygen in that breath, and that freaks the body out) that causes the blood vessels to open up instantly — creating a change in the size of the tube, which then of course causes the blood to slosh around creating -- you got it, turbulent flow. 2. Stress. Unsurprisingly, stress causes stress hormones that do the same thing as smoking. 3. Changes in blood vessel geometry. Adding corners and bends to blood vessels also add areas of acceleration and changes in velocity. 4. Blood viscocity. Viscosity is the tackiness (how much a fluid sticks to itself) of a fluid. Water has a lower viscosity than, say, honey or motor oil. When a fluid is more viscous it does not travel down a tube all together, but tends to clinging to itself, creating turbulent flow. High blood sugar can is the most common cause of viscosity-induced turbulent flow. The higher your blood sugar, the more your blood is like syrup. For cardiovascular health, what do you need to address before running and jumping and medicating? 1. Stop smoking. Really. Are you still doing that?

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2. Start meditating, or at very least do all the other stress-reducing things that you already know you should be doing. 3. Alignment. 4. Watch your blood sugar. But you already knew that too, didn’t you. When we talk about CV disease you will rarely hear about the mechanisms — only the symptoms (like plaque). A correct, thorough prescription for prevention (or treatment) of CV disease should start with the items listed above.

Key Points 1. We have made the entire science of cardiovascular disease about fat and cholesterol and chemistry, when it is really about geometry. 2. If you are not aligned correctly, you are creating damage on the cellular level by placing bends in vessels that should be otherwise straight the bulk of the day. 3.Stress, high intensity exercise, smoking, and high blood sugar are some variables that have a negative effect on the way blood flows through the arteries. 4.Turbulent flow is the greatest mechanical cause of plaque formation. 5. Laminar flow is the best for moving fluid and cells in the same direction. 6. Turbulent flow is caused by: •

rapid change in tube diameter (smoking or stress)

•

a change in blood flow velocity (e.g. when blood has to “squirt”)

• old, accumulated plaque or inherent or artificial geometrical changes in the vessels 7. The plaque formation process is cells scraping vessel walls and leaving a wound, which then gets “scabbed” mainly by cholesterol and calcium.

References American College of Sports Medicine Position Paper, Exercise and Hypertension, FRANKLIN, B. A., M. H. WHALEY, and E. T. HOWLEY (Eds.). ACSM’s Guidelines for Exercise Testing and Prescription,6thEd. Baltimore: Lippincott Williams & Wilkins, 2000. KELLEY, G. A., and K. S. KELLEY. Progressive resistance exerciseand resting blood pressure: a meta-analysis of randomized controlled trials. Hypertens. 35:838 – 843, 2000.

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KELLEY, G. A., K. S. KELLEY, and Z. V. TRAN. Aerobic exercise and resting blood pressure: a meta-analytic review of randomized, controlled trials. Prev. Cardiol. 4:73– 80, 2001. KELLEY, G. A., K. S. KELLEY, and Z. V. TRAN. Walking and resting blood pressure in adults: a meta-analysis. Prev. Med. 33:120 –127, 2001. KELLEY, G. A., and K. K. SHARPE. Aerobic exercise and resting blood pressure in older adults: a meta-analytic review of randomized controlled trials. J. Gerontol. A Biol. Sci. Med. Sci. 56:M298 –M303, 2001. MACDONALD, J. R., J. M. ROSENFELD, M. A. TARNOPOLSKY, C. D. HOGBEN, C. S. BALLANTYNE, and J. D. MACDOUGALL. Post exercise hypotension is sustained during subsequent bouts of mild exercise and simulated activities of daily living. J. Hum. Hypertens. KIVELOFF B., and O. HUBER. Brief maximal isometric exercise in hypertension. J. Am. Geriatr. Soc. 19:1006 –1012, 1971. in humans. Hypertens. 18:575–582, 1991. Review Questions: 1. What does "haemodynamics" mean? 2. What creates arterial plaque? 3. How does skeletal muscle play a roll in circulation? 4. Name three things that affect the flow of blood. 5. How do each of these things affect the flow of blood? 6. What causes turbulent flow? 7. If you wanted to reduce arterial plaque and the hardening of the arteries, what haemodynamic variable would be the BEST to target? 8. What are the health reasons we should do cardiovascular exercise? 9. Why are they valid? 10 Why are they invalid? 11. What role does alignment play in cardiovascular health? 12. What exercises of the first 10 should be avoided/modified if one has a hip replacement? 13. What musculoskeletal movement aligns the "knee pits"? 14. What muscle generates this movement? 15. What muscle group do people tend to do this motion (from Question #13) with at first? 16. How can they tell if they are using the correct muscle group?

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The 25-Point Alignment Program

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The 25 Alignment Points Stance (5 points) Head of the 5th Metatarsal (R and L) Lateral Malleolus (R and L) Ankle Joints Pelvic Width Frontal Plane Plumb Line 1 (5 points) Ankle (mid-point) Knee (mid-point) Hip (mid-point) Gleno-Humeral (mid-point) Ear Frontal Plane Plumb Line 2 (3 points) Pubic Symphysis ASIS (Anterior Superior Iliac Spine) 10th Rib (bottom true rib) Sagittal Plane Plumb Line 3 (6 points) GH Joint (R and L) Elbow Pit (R and L) Wrist (with thumb pointing forward) Shoulder Girdle (1 point) Scapula - protraction (no bony edges) (1 point) Lower Body (5 points) Sacrum - Posterior vs. Anterior and Nutation vs. Counter-Nutation Knee Tendon Attachments to allow sagittal flexion (knee pits) (R and L) Ball of the foot to ground (R and L) The skeleton, while an organic and living tissue, cannot move itself. Joints, the couplings between skeletal pieces, are also unable to change position without an external force. The resting tension of skeletal muscles and myo-fascial tissue that have been shortened by habitual non-natural movements or postures will often prevent Alignment Points from being positioned correctly. The practical application of this alignment program is to: 1. Mobilize. Joints have full range of motion in order to achieve 25 Points of Alignment while static (standing). 2. Stabilize. Muscles have length to optimize metabolic and mechanical pathways for the endurance to be able to maintain 25 Points of Alignment while dynamic (walking). 3. Functional...ize. Be able to maintain (and derive) the optimal alignment for functional, athletic, or enjoyed tasks. 41

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Side view alignment

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Pelvic Alignment

Shoulder Girdle Alignment

Scapulae wide and flat

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Alignment of the feet and ankles

Alignment of the knee pits (hip rotation)

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The First 50 Exercises

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1. THE CALF STRETCH Objective Markers: • Foot alignment • Back heel on floor • Center of mass (pelvis/weight) over back foot • 2 straight legs- plumb line • Fully extended knees • ASIS & shoulders square/in same plane Purpose: • Lengthen stride- to be able to keep heel on ground as long as possible, for the longest lever possible during posterior-driven gait • When calves are really tight, the lower body is moving slower than the upper body, creating a whip effect or like a wave cresting over Observing: • Stride length - Negative: “front” or non-stretching heel behind heel of stretching foot - Even: heel of non-stretching foot hasn’t cleared the toes of the stretching foot - Positive: Heel of stretching foot clears toes of stretching foot • Twisting pelvis or shoulders • Balance

2. TOP OF THE FOOT STRETCH Stand up and reach one leg back behind you, tucking the toes under. If the foot cramps, take a rest, then return to the stretch. Objective Markers: • All 5 toes tucked under • Top of foot presented forward • Hip of non-stretching (front) foot over or behind front ankle • Don’t let ankle move laterally • Extend from hip and fully extend knee (eventually) Purpose: If you have worn heels throughout your life, participated in sports, or tend to thrust your pelvis forward when standing, the muscles in the feet are extremely tight. This will help to restore full neurology to the foot. 47

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3. THE MONSTER WALK Objective Markers: • Foot Alignment • Land in heels • Fully extended legs/knees • Pelvis static- horizontal waistband • Walk in lateral straight line • Still upper body Purpose: •True abduction, with proper foot position. Allows glutes to contract other directions (than they normally do) to let sacrum float out posterior. Use hips instead of ankles. Teach heel strike. •Use as neurological screening tool and it is a pseudo-stress situation, so can observe habits under stress •Observe movement habits: neck/head, shoulders/hands/arms, knees *Modifications for Hip Replacement: no band around ankles (no loading)

4. KNEE CAP RELEASE The best indication you can straighten your leg (but not lock your knee) which lets you know you are using your hip. Start with straight legs - no bent knees! Try to lift and lower your knee caps. Objective Markers: • Fully extended knee • Relaxed quadriceps Remember: Your kneecaps can’t relax if your knees are bent. Find a wall to lean against if you are having difficulty.

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5. THE PELVIC LIST Pelvis moving around femur- use musculature down lateral side of leg (IT band, TFL) connect below knee, hip moves down toward foot- not using waist or QL (quadratus lumborum) Objective Markers: • Foot alignment • Heel all the way on block- toes don’t matter • Fully extended knee • ASIS even in frontal plane- no twisted pelvis • Arms down • Both feet next to each other and symmetrical (watch floater leg) Observing: • Habits • Habitually off the Objective Markers • Hip mobility, lateral hip strength/motor skill *Modifications for Hip Replacement: no block, keep both feet on floor

6. THE STRAP STRETCH Stretching hip relative to foot. The specificity of the stretch makes it specific to gait (I) Straight (II) Across midline (medial) (III) Lateral (inner thigh)- can also be done prone Objective Markers: • Straight foot edge • Fully extended knee • Relaxed quad (muscle inhibition doesn’t actually change resting muscle length) • Bottom leg fully extended- hams. on floor • Keep bottom leg toward midline- don’t let it migrate laterally • Static pelvis • Eversion of foot • Ankle dorsiflexion I.

II.

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III.

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7.THE DOUBLE CALF STRETCH Great for “untucking” the pelvis. Place your hands on the seat of a kitchen/ desk chair. Line up the outside edges of your feet and straighten your legs all the way. Your weight should be back in your heels and all your toes liftable. See if you can lift your tailbone up to the ceiling without bending your knees! Objective Markers: • Foot alignment • Heels on floor • Knees fully extended • Lift tailbone so that neutral pelvis is parallel to floor (eventually) • Arms fully extended • Relax spine

8. THE THORACIC STRETCH Objective Markers: • Straight wrist (a dropped wrist appears that they’re dropping lower than they are) • Hips posterior to ankle joint (not plumb), weight in heels • Foot alignment • Fully extended knee • Neutral pelvis • Tailbone higher than waistband • Sit bones horizontal Observing: • Tailbone-ant/post tilt • Lumbar spine- flex/ext • Thoracic spine- flex/ext • Cervical spine- flex/ext • Rotation or lateral flexion (of spine) • Symmetry/Asymmetry • Check for where any of the above might be coming from- bend knees to check if it’s a mobility issue or a flexibility issue Note: If shoulders are very internally rotated- can put hands on chair seat so don’t have to lift arms to shoulder height

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9. THE HEAD HANG Relax chin to chest. Objective Markers: Chin should touch the chest (eventually) Purpose: Get the posterior neck muscles to correct length

10. THE RHOMBOID PUSH-UP With head hanging, let shoulder blades move together – hold a few seconds. Reverse directions and spread shoulder blades wide (don’t tuck pelvis!!). Objective Markers: • Hands directly under shoulders • External rotation of humerus • Knees directly under hips and pelvis-width apart • Neutral pelvis • No bony edges on medial aspect of scapulae • Head relaxed Purpose: To restore full length of rhomboids.

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11. HEAD RAMPING Objective Markers: • Ear over shoulder • No folded skin on back of head Purpose: To align the trachea and blood vessel geometry. To decrease the compression of the cervical discs.

12. THE PSOAS LUNGE Objective Markers: • Feet/Knee should be pelvis width apart • Front ankle should be beyond front knee Purpose: To lengthen psoas Beware the rib thrust!

Advanced Keep the ribs down.

13. QUADRUPED TVA ACTIVATION Objective Markers: • Quadruped markers: Wrists under shoulders, knees under hips, neutral spine • Hand head • Relax low belly • Activate transverse abdominus (TVA) on exhale- PELVIS SHOULD NOT MOVE! Purpose: • Practice abdominal yield • Locate and fire transverse abdominals • Identify confusion in abdominal/psoas firing

Relax the belly

Activate TVA 52 on exhale

Pelvis doesn’t move

Whole Body Alignment

14. RIB TWIST (FROM QUADRUPED) Objective Markers: Quadruped markers: Wrists under shoulders, knees under hips, neutral spine Purpose: • Lengthening abdominal musculature (obliques, psoas) • Increase stretch to shoulder girdle and rib musculature

1

2

3

4

15. PRONE INNER THIGH STRETCH Objective Markers: • Start prone (face down) • Bring one leg out to the side until eventually, legs are at a right angle • Maintain femoral external rotation (Don’t allow knee to roll to the floor) Purpose: Adductor and hip rotator stretch

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16. BLOCK KNEE SQUEEZE

!Objective Markers: Starting on back, place block between then knees Keeping knees together, pull ankles as wide as possible Purpose: • Adductor strength • Stretch internal rotators • Identify psoas tension (the tighter the psoas, the harder it is to keep the knees together) • •

17. RIB DROP Objective Markers: In standing alignment, lower anterior ribcage until they are directly over the ASIS/ Pubic Symphysis in the frontal plane

Ribs lifted

Ribs lowered

Purpose: • Decrease hyper-extension of lower thoracic vertebrae • Increase innervation of abdominal musculature • Decrease compression of spinal disks and bone

18. STOMACH RELEASE Objective Markers: • Quadruped Markers • Spinal extension and neutral pelvis • Downward motion of the abdominal wall Purpose: Cease upward tension on diaphragm and constant, upward force

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Ribs lowest Exposes forward head

19. PSOAS EVALUATION Objective Markers: • Begin with legs fully extended and quadriceps relaxed (soft) • Hamstrings should rest on the ground • Lift torso by flexing at the hip until legs are relaxed and resting on the ground • Support torso with pillows • Angle of torso to thigh is created by psoas tension Purpose: Identify length of psoas

Lie Flat to see if hamstrings touch

Do you have to arch your back to get the thighs down?

Before :

After

Add Bolster under upper shoulders (but not ribs)

Lie Flat after release!

20. PSOAS RELEASE ON BLOCK

!Objective Markers: • Pelvis elevated on block or bolster • Pelvis should be able to passively post-tilt, allowing lumbar flexion Purpose: To identify and release/cease habitual spinal extension and Psoas tension

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Whole Body Alignment

21. THE CRESCENT STRETCH Objective Markers: • Frontal plane motion only • Both scapula and both glutes press evenly into the floor • Outside leg crosses over inside leg (avoid this if client has artificial hip) Purpose: • Lengthening lateral musculature: Obliques, IT Band, quadratus lumborum, and lateral flexors of the vertebrae • Can also stretch intercostals and shoulder girdle muscles

22. THE SPINAL TWIST Objective Markers: • Begin with neutral pelvis • Bring one knee towards chest until hip flexes to 90 degrees • Rotate pelvis until knee touches the ground • *Note if the entire spine rotates (See Spinal ROLL pic) - there is no oblique/ abdominal range of motion • Opposite ribcage, scapula, elbow, forearm, and wrist to floor Purpose: • Compression of abdominal aorta • Lengthening of the oblique and deeper abdominal musculature • Lengthening of the vertebral rotators • Elongation of psoas • Lengthening of the shoulder girdle musculature

Spinal Twist

Spinal ROLL

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Whole Body Alignment

23. FEMUR INTERNAL/EXTERNAL ROTATION Objective Markers: • Foot Position • Knee-Pits aligned posterior (i.e. hamstring tendons parallel in frontal plane)

Internally rotated

Externally rotated

Purpose: Optimal alignment of the femur in the hip joint to allow for proper hip and knee (sagittal plane) flexion and extension, alignment of the lower leg bones to reduce excessive friction in the knee joint

24. FOREARM PUSH-UP WITH EXTERNAL ROTATION Objective Markers: • Quadruped and Hand Placement • Maintain external rotation of humerus throughout exercise (i.e. elbow pit point forward, olecranon process points back toward thigh) Purpose: Strengthen lat/triceps connection, strengthen humeral external rotators, get out of cervical compression, trapezius habit, reduce humeral internal rotation

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Whole Body Alignment

25. POSTERIOR BLOCK HOLD Objective Markers: • Squeeze block between palms (not using fingers) • Depress and squeeze scapulae together (try to get arms to disappear behind body) Advanced: maintain external rotation of humerus, squeeze elbows more than palms (keep hands loose on block) Purpose: Move shoulders into external rotation, while coordinating shut-off of trapezius muscles

26. HAND STRETCHING Objective Markers: Middle finger, wrist, elbow, and shoulder in line Purpose: Regain appropriate length of muscles of palm and each finger, increase blood flow and neurology to hands

Whole hands - fingertips only touching the ground

Fingers

Thumbs

27. FOREARM STRETCHING Objective Markers: Wrist, elbow, and shoulder in plumb line Purpose: Lengthening muscles of forearm and back of hand

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Individual fingers

Whole Body Alignment

28. FLOOR ANGELS Objective Markers: • Ribs down • Palms up, external rotation (elbows roll up toward ceiling as back of wrist moves toward floor)bolster head as necessary if cervical spine moves into hyperextension Purpose: External humeral rotation, stretching pectoralis to open chest and shoulder

29. WINDMILL Objective Markers: • Neutral pelvis (start by drawing knee over hip joint, then move knee across body toward floor) • Keep knee on floor •

Moving in a “backstroke” direction palm up when arm goes behind body, flips over to palm down as it passes hip, then flip back to palm up as arm comes over head

•

Maintain external rotation and scapular depression

Purpose: Opening chest and shoulder joint, regaining full ROM of shoulder joint

30. SUPINE THORACIC STRETCH OVER DOME Objective Markers: • Place1/2 dome at apex of thoracic curve • Bolster head if cervical spine moves into hyperextension • Allow ribs to relax towards floor, increasing thoracic spinal extension Purpose: Reduce hyper-kyphosis, mobilize spinal extensors

Ribs up

Whole hand

Ribs down

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31. POSTERIOR ARM REACH Objective Markers: • Reach arm behind back, palm facing out • Working toward elbow directly under shoulder and middle finger reaching up toward C7 • Increase elbow flexion to increase stretch Advanced: Keep scapula from winging Purpose: Mobilize humeral internal rotators and deltoid

32. POSTERIOR ARM REACH W/SUPINATION Objective Markers: • Reach arm behind back, working toward elbow directly under shoulder and middle finger reaching up toward C7 • Supinate lower arm, to place palm flat on back. • Increase elbow flexion to increase stretch Advanced: Keep scapula from winging Purpose: Mobilize forearm supinators

33. CLICK CLACK Objective Markers: • Fully extended elbow • Chest lifted/thoracic extension • Eyes and chin level • No cervical movement • No thoracic movement • Feet 2x pelvis width *Helpful for practitioner to use knee in back to teach how to move pelvis this way Purpose: Articulation of pelvis in sagittal plane (correct ROM at hip joint and lumbar spine).

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Whole Body Alignment

34.LEGS ON THE WALL

! Objective Markers: • Neutral pelvis • Knees fully extended • 1) Relaxed position • 2) Dorsiflex feet and externally rotate femurs Purpose: Restore length to adductors

35. COBBLER’S STRETCH (SUPINE) Objective Markers: • Soles of feet together • Knees open towards floor • Ribs neutral Purpose: Stretch groin

36. CROSS-LEGGED COBBLER (SUPINE)

! Objective Markers: • Cross ankles or one ankle on top of other knee • Knees open towards floor • Ribs neutral (watch thrusting) Purpose: Stretch groin and psoas

37. #4 STRETCH (seated) Objective Markers: • Cross one ankle over opposite knee • Foot on floor directly below knee • Work towards shank of crossed leg parallel to floor • Maintain neutral pelvis, sitting on ischial tuberosities (don’t tuck) • Can also be done supine Purpose: Lengthen piriformis, increase hip ROM

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38. INDIVIDUAL TOE LIFTS

! Objective Markers: • Lift big toe while keeping all other toes down • Keep it pointing straight ahead, not laterally toward other toes • Keep ball of foot in contact with floor, don’t roll up medial side of ball • Then lift #2 toe, then #3 toe, then #4 toe, then put them back down one at a time Purpose: Restore full neurology to foot. 25% of bones and muscles in body from ankles down. Musculature of big toe greatest of muscles in foot

39.TOE SPREADING Objective Markers: Abduct all toes away from each other Purpose: Restore space between metatarsal bones of foot, restore length to muscles between metatarsal bones

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Whole Body Alignment

40. DOUBLE CALF STRETCH W/EXTERNAL ROTATION Objective Markers: • Same as Double Calf Stretch (Foot alignment, Heels on floor, Knees fully extended, Lift tailbone so that neutral pelvis is parallel to floor (eventually), Arms fully extended, Relax spine) •

WITH knee pits aligned directly posterior (i.e. hamstring tendons parallel in frontal plane)

Purpose: Fully involve all posterior leg musculature

Begin (and continue) stretch with hips in external roation

41. SOLEUS STRETCH Objective Markers: All Markers for Calf Stretch (Foot alignment, Back heel on floor, Center of mass (pelvis/weight) over back foot, Fully extended knees) Then bend knee of stretching leg Purpose: Increase length of soleus (an essential component of the squat) and increase neurology and circulation to the foot

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Whole Body Alignment

42. SQUAT PREP 1: SUPINE FULL KNEE & HIP FLEXION Objective Markers: Neutral Pelvis Purpose: Prepare knee joints and hip joints for full flexion in the eventual weighted full squat

43. SQUAT PREP 2: SHANK ROTATION Objective Markers: Rotate shank (lower leg bones) independently of femur, relative ankle and foot position do not change Purpose: Increase lower leg mobility specifically popliteal muscle

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Whole Body Alignment

44. SQUAT PREP 3: 90° SQUAT WITH ELEVATED HEELS

! Objective Markers: • Feet slightly wider than hip-width with knees aligned with ankles • Feet straight • Untuck pelvis • Stretch heels toward floor • Make sure knees haven’t twisted and weight is even and not favored on one side (see pic at bottom right) • *Rolled yoga mat behind knee joint helps to create more space at joint if needed Purpose: Prepare calf muscles and knee joints for increased ROM for full squat

Watch foot & knee alignment

Watch twisting or weight favored on one side

45. SQUAT PREP 4: FULL KNEE/HIP FLEXION SQUAT WITH ELEVATED HEELS Objective Markers: Knees at full flexion Let center of mass fall as far toward floor as possible Untuck pelvis (maintain neutral pelvis) Use rolled yoga mat under heels as needed (eventually getting heels on floor) Purpose: Increasing hip and knee flexion as next step toward full Squat

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Whole Body Alignment

46. SQUAT PREP 5: FULL KNEE/HIP FLEXION SQUAT WITH DOOR Objective Markers: Untuck tailbone (neutral pelvis) Knees aligned over ankles– perpendicular shanks Heels on floor (eventually) Purpose: Optimize low back, pelvic floor, and digestive system health. Holding onto a door knob will help until your legs are strong enough (and loose enough) to hold this position for a minimum of one minute. A rolled towel or yoga mat under the heels will also make this exercise easier to start. Work up to doing it with your heels on the ground.

Neutral pelvis, knees over

Tucked pelvis, knees too far

47. TRICEPS LOWERS (ECCENTRIC) Objective Markers: • Quadruped markers (wrists under shoulders, hips over knees, neutral pelvis, externally rotated humeri) • Lower elbows toward floor, maintaining external rotation (elbow pits forward) • Don’t back hips up (bottom pic) Purpose: Strengthen triceps, external rotators, lats

Don’t back hips up! 66

Whole Body Alignment

48. SINGLE LEG GLUTE CONTRACTION (ARABESQUE) Objective Markers: • Foot straight • Quads relaxed (kneecaps liftable) • Hips slightly posterior to heel • Level pelvis Purpose: Posterior leg strength

49. SINGLE LEG HAMSTRING STRETCH WITH WALL

! •Objective Markers: • Feet straight (both) • Pelvis neutral • Both knees fully extended • Working up to 90° legs (one relative to the other) • Work up to hands on wall Purpose: • •

Hip and hamstring opener Standing leg strength

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Whole Body Alignment

50. STANDING RUNNER’S STRETCH WITH FORWARD BEND

! Objective Markers: • Standing leg foot straight and fully extended knee • Hold onto front of ankle (not toes) • Keep ankle and knee aligned with hip • Forward bend from hip not flexing spine forward (see pic at bottom right) • Keep ASIS level -no twist- and bent leg in line with torso Purpose: Hip, Psoas, and Quad opener

Starting position.

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Whole Body Alignment

Trunk, Core, Pelvic Floor Physics

Our own physical body possesses a wisdom which we who inhabit the body lack. We give it orders which make no sense. ~Henry Miller

The core of the body is, essentially everything the arms and legs attach to. From the breathing diaphragm to the pelvic floor, the alignment of this area is crucial as the greatest length of the spinal column (and therefore spinal cord) passes through it. The ability for the spinal cord to optimize its job requires no unnecessary stresses, like inappropriate bends and kinks. The alignment of the trunk is essential as position is what gives muscles their “strength” or, ability to generate the correct amount of force. The four layers of abdominal muscle require the ribs and pelvis to be in their correct position for these layers attach to otherwise flimsy cords called raphe (ray-phee). These cords, when under the correct tension, have the ability to offer a fixing point equal to bone in strength.When the cords are not tightly pulled on each end, they offer a much more gelatinous connection. How can a muscle that attaches to yielding tissue generate internal leverage? It cannot.

Posture and core function

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Whole Body Alignment

Three Abdominal Raphe The Linea Alba: A fibrous band that runs vertically along the center of the anterior abdominal wall and receives the attachments of the oblique and transverse abdominal muscles. It also connects the xiphoid with the pubic symphysis & crest. The two linea semilunaris are each a curved tendinous line placed one on either side of the rectus abdominus. Each corresponds with the lateral border of the rectus, extends from the cartilage of the ninth rib to the pubic tubercle. Umbilical hernias: At the umbilicus hernias can develop due to developmental deficiencies, congenital umbilical hernia, or may occur due to a weakness in the linea alba in the area of the umbilicus, an acquired umbilical hernia.

Cultural-based habits, such as tucking the tailbone for modesty’s sake or sucking in the stomach for a flatter-looking abdomen are habits that have significantly altered the mechanics in this area. The posterior tilt of the pelvis (tucking the tail between the legs) is a body position that limits the hip’s ability to extend. This lack of extension reduces, if not eliminates, the ability for the hamstring to contract during the gait cycle. The walker is now left with the options of leaning forward (creating downward momentum to initiate a pull forward) or hip flexing (lifting the leg out in front) and falling forward. This habit creates limitations and high landing forces in the ankles, knees, and hips. The lack of hip extension while walking is also the primary cause of pelvic floor issues. In a natural gait cycle, the hip extension-push off not only uses the hamstring but also creates a regular, steady activity in the gluteus maximus -- a muscle that opposes the pelvic floor’s action on the sacrum. Sucking it in The constant upward force of “sucking it in” is generated by an upward use of the diaphragm. This upward force opposes all natural, downward functions of digestion, elimination, menstruation, birth, and circulation. The first step to developing optimal core musculature function requires a cessation of this habit. The abdominal release is a great place to start -- feeling the stomach drop against gravity is the relaxed sensation amplified. The uncomfortable feeling comes from the diaphragm relaxing back into its natural (and neutral) position. It is important to not interfere with the diaphragm as this muscle has large biological responsibilities of vomiting, coughing, and remaining supple during breath. Vanity has a high tax when you think about it! The Psoas 70

Whole Body Alignment

The lumbar plexus (group of nerves) is situated, in most people, between the psoas’ layers. This means that the health of these nerves requires regular use of the psoas -Psoas Fast Facts The psoas has two layers: deep and superficial. DEEP: Attaches to the costal processes of lumbar vertebrae I-V. SUPERFICIAL: Attaches on the lateral surfaces of T-12, L I-IV, and from the neighboring intervetebral discs. Both layers blend with the iliacus and all attach at the lesser trochanter of the femur.

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which requires the psoas to be innervated at its full length. Use the psoas protocol to measure the resting length of the psoas. Which muscles are innervated by the lumbar plexus? • Transversus abdominis (Abdominal) • Abdominal internal oblique (Abdominal) • Cremaster (Men’s pelvic floor) • Obturator externus (Pelvic floor - deep hip rotator) • Adductor longus (Adductor) • Gracilis (Adductor) • Pectineus (Adductor) • Adductor magnus* (Adductor) • Iliacus (Hip flexor) • Psoas major (Abdominal) • Pectineus (Adductor) • Sartorius (Adductor) • Quadriceps femoris (Quadriceps) • Quadratus lumborum (Abdominal) Core Strength The optimal function (and therefore appearance) of the trunk requires two things: Alignment and regular use. Sit-ups and other types of exercises are designed to “target” this chronically underused area. But because trunk muscles require pelvic and rib stabilization to work, and because this stabilization requires the large muscles in the legs and chest to be innervated correctly, it is futile to continue to find core strength in this manner. This is not to say that practicing various motor skills in this area are a waste of time, but only that the strength (and aesthetic) you are desiring in this area has much more to do with mastering a strength-to-weight ratio (achieve a pull up and you will have a huge increase in core tone between the ribs and pelvis!) then it does with a bunch of crunches.

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Poisson’s Effect When a compressive load is applied to an object, the object will both deform in the direction of the load as well in a direction that is perpendicular to the applied force. An example of this in the human body is the unnatural load of a non-supported vertebrae pressing on a spinal disc. Poisson’s effect also occurs in the opposite direction as well. When a tensile load increases the length of an object along an axis, there occurs a simultaneous, perpendicular compression (medial motion).

Another human-tissue example is the net effect of the transverse abdominal muscle fiber contracting about the abdominal viscera. The resulting motion is a gentle torso lengthening (and spinal decompressing) action.

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Prenatal Fitness does not equal pregnancy preparation When we think of birthing culture it is common to focus on the social aspects alone, neglecting to identify how our more modern habits have affected the physical structures and physiological processes that occur daily. The most fascinating of these physical adaptations has been the changes in pelvic telemetry in the more affluent-yet-sedentary cultures as compared to those populations that are more mobile. The whole-body mobility of the human has decreased over the ages, as the necessity for movement waned with the development of stationary farming, then industry, and more timely, the increase in technology. Each of these human developments has its negative impacts on the health of the human, as the physical machinery that makes each of us up is dependent on the original quantities and qualities of movement -qualities and quantities that have been absent in our world-wide population for hundreds, if not thousands of years. This lack of whole-body mobility is a fascinating science when considering mobility’s role in various human functions, from blood pressure regulation to, of course, birthing. Perhaps the single greatest human process, birthing has not been unaffected by these changes. In fact, the vaginal delivery process may be the most at-risk as our population moves farther and farther from the natural biological reflex-based types of movements (i.e. long-distance migrations, squatting for elimination, barefoot gait patterns) to excessive chair sitting, toilet use, and using “exercise” to compensate for lack of all-day body use. The state of our physical body has become an anatomical hindrance to the natural birthing process. Tense pelvic floor muscles and an unchangeable position of the sacrum relative to the pelvis causes great interference and begets large, damaging forces. Once a highly mobile joint with the ability to nutate and counternutate, maximizing the obstetrical conjugate in a timely manner, chronic tension in the pelvic floor from excessive kegels, minimal gluteal strength, and an unyielding piriformis reduces what was once (relatively) abundant birthing space. Modern birthing science has placed a large burden on secreted hormones (like relaxin) to prepare the body for needed mobility. These hormones are truly designed for noncontractile tissues (like ligaments) and are not able to override chronic muscle tension. Relying on relaxin alone can lead to excessive tension and possible damage to the muscles (the pelvic floor, especially), and, frankly, is only one half of the natural process. A natural birth is served both physiologically and anatomically by mimicking a natural movement plan, to the best of her ability, for the bulk of her pregnancy. This is how it has been done for thousands of years! Midwives have been tuned into this natural preparation for many years, often recommending squatting to prepare the body and maintaining an active walking habit throughout the pregnancy. What often gets lost in translation is the fact that this movement prescription is birthing preparation as opposed to simply prenatal fitness. 74

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Just like marathon training needs to be stretched out over many months for a successful outcome, human body adaptation takes many months to develop. Removing years of accumulated muscular and joint stiffness to allow the natural birthing instinct to fully flourish without anatomical resistance can provide an optimal outcome, naturally In 1931, the British Medical Journal published an excellent article by Kathleen Vaughan, M.B. (Bachelor of Medicine), a researcher investigating the difficulties in birthing between the “civilized” populations of London and the ease of birth and the better mother/baby outcomes in the Gypsy or “Tinker” populations: In England the still soft pelvis [of the pre-pubescent] is bent by long sitting at school, and this is not couteracted as it should be by the proper action of the sacro-iliac joints, which should be used daily, if only during the acts of defaecation [sic.] and urination. The wearing of high heels also limits and cramps their movements, the body weight is thrown forward on to the arch of the foot instead of the heel, the pelvic angle is altered, and the back unduly hollowed to preserve the balance. That these facts are the real explanation of our increasingly difficult maternity is clearly seen when we compare them with the conditions where motherhood is still natural and easy. The woman who wants to go about a birthing process naturally can follow the lead other “natural” processes women have been doing for millennia – walking 5-6 total miles per day, and making the squat a regular, daily exercise. The reality is, for the modern, Western mother-to-be, a musculoskeletal “training program” can optimize a safe and fluid delivery, and enhance optimal long-term health of mother and baby. Needing to “train” for delivery does not imply that the birthing process is not natural, but only that the mother has allowed her “birthing equipment” to adapt to an unnatural lifestyle (sitting in chairs five to ten hours a day, not stretching the bathrooming muscles of the pelvic floor and legs, etc.) and has become out of shape when it comes to whole-body endurance. Whole-body endurance means the ability to walk long distances using the strength of the legs. Being able to support oneself with leg strength will come in handy when needing to labor for an extended (but hopefully not too extended) amount of time. Cycling, aerobics, running, and swimming will not get you a stronger strength-to-weight ratio. A “hunting and gathering” mother would do well to mimic the daily required walking that keeps her birthing muscles in top form. Delivery Preparation Exercises 1. If mama is not walking at all, begin with one mile, increasing the distance by 1/2 a mile every two to four weeks, until hitting five to six miles per day. Doing all the mileage at once will help with endurance, but breaking up the distance over the course of a day will help if fatigue or soreness is an issue. Implement a squatting program. Hamstring and calf tension (the two major muscle groups down the back of the legs) tuck under the tailbone and pelvis, instantly impacting the size of the obstetrical conjugate.

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Barefoot time should be increased (about the house is fine) and positive-heeled shoes should be removed from the Mama-to-be wardrobe until after delivery as they shorten the muscles down the backs of the legs. Incidentally, this information applies not only to expectant mothers, but to anyone wanting to retain function of the pelvic floor, digestive system, hips and lower back health for an entire lifetime. Any birthing professional who prescribes these exercises (and they should!) should be doing these exercises herself - as a model of pelvic health.

Pelvic Floor images from Grey’s Anatomy

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Psoas Review Questions: 1. What two basic (major) skeletal displacements can the PSOAS accomplish? 2. What is stress? 3. Using the biological definition, what is a common stress-response generator for you, personally? 4. What is the purpose of the psoas exercises? 5. What general direction does the psoas run? To Do: 1. Try to catch yourself using the term "stress" inaccurately, and observe (you don't have to change) how you react to your biological signals. 2. Observe your rib thrust and develop a regular practice of psoas releasing for the next few weeks until you lie flat comfortably.

Abdominal Review Questions

1. What are the layers called, and how are they orientated (fiber direction), deep to superficial? 2. How is core musculature involved in spinal tissue health? (Specifically) 3. How is core musculature involved in cardiovascular health?(Specifically) 4. What is Poisson's Effect? What are the two areas in the body affected by it? 5. What do most abdominal muscles attach to in order to generate leverage? 6. What affects the effectiveness of this arrangement? (Quantity of leverage?) 7. What area in the body is the most likely to develop arterial plaque?

Why? 8. What exercise is an "essential" for spinal and abdominal health? Why? 9. What alignments instantly weaken the core musculature? 10. What spinal alignment is "rib thrusting" often hiding?

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Shoulder Girdle "He's got the whole wide world in his hands" - hymnal Spirituals Triumphant, Old and New

In no area of the body is the strength-to-weight ratio more off than in the shoulder girdle. Our time spent living away from nature has practically eliminated all functional activity (lifting large objects, hauling our our full body weight up and lowering it down) but it is our lack of walking (again) that has interfered with the natural development of this area. Although counter-intuitive, perhaps, the role of the shoulder girdle while walking is just as important to balancing gait forces on the spine. If we had walked the distances our machines required from childhood, the posterior arm swing (opposing the opposite leg’s posterior push off) would have created chest muscle lengths that allowed a neutral arm shoulder position. Instead, we place children in strollers. And walk with our hands fixed pushing them. We pump are arms out in front to “increase the burn” but fail to use the 1/2 of the shoulder girdle’s muscles located on the back half of the body. We haul purses, and *stuff*, changing the lengths and functionality of this area of the body.

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Well, big deal. It’s not like we need strength to pull ourselves up the side of a mountain. And while it is true that we can absolutely survive without tremendous capability in this area, the lack of natural shoulder motion has had a huge impact on the way we breathe. While oxygen intake can occur in various ways, the largest volumes and the smallest biological damage requires simultaneous upward movement of the individual ribs to increase the volume of the thoracic cavity. Breathing in this manner requires a stabilized shoulder girdle. This requires appropriate tone in the upper body’s muscles as well as optimal tone in the abdominal muscles (needed to anchor the ribs to the trunk. When the shoulder girdle is free to float in various positions, the intercostal muscles cannot generate leverage and breathing must happen via belly inflation (which increases the pressure on lumbar intervertebral discs) or by elevating the thoracic cavity away from the diaphragm (increasing pressure on cervical intervertebral discs). Just as whole-body muscle innervation is required for oxygen delivery, shoulder stabilization is required for taking in the to-be-delivered oxygen! Why do our arms swing when we walk? The best, most muscle-building, calorie utilizing, metabolism enhancing, heart strengthening, and blood circulating gait pattern is one that is smooth and symmetrical. All of your body mass is moving in one direction – forward. Think of the bouncy walker. It does look pretty cute, I’ll admit, right up until you open up the knee and hip joints and see what that bounce does to the cartilage in the joint. Ouch. When you walk forward, it is supposed to be due to the fact that one leg pushes off behind you (most people lift a leg out and fall forward, but that’s a different blog). So now you have your right leg behind you, pushing back. That large quantity of mass (our legs make up quite a bit of our body weight) can tend to twist your pelvis around, creating torque on your spine. There needs to be something to balance out the twisting tendency walking creates on the spine. The easiest thing to do is reach the arm back on the opposite side of the body, to help balance the twist. It’s called reciprocal arm swing. The opposite sides of the body reach back at the same time, an arm on one side and a leg on the other. A backward reaching arm is not only great for reducing overuse of the spine, it is a nature-designed workout for the backs of the upper arm. Awesome! Lifting the arm up behind you keeps your tricep muscles toned and the armpit lymph free. If you thought three sets of 12 tricep exercises with a 5 pound weight were effective, just wait until you use your arms correctly when walking. It tones those arms right up! When you are out walking, you are going to see another strange phenomenon. People are lifting their arms out in front of them because they think that makes means they are working harder and burning more calories. Sorry! Pumping your arms out in front creates extra tension in the front of the shoulders, muscles that are usually already super tight and fatigued from computering, driving, and sitting all day. The tighter the muscle, the less calories it burns. This forward motion tenses the trapezius and neck muscles too. And, if you aren’t swinging your arms behind you when you walk, there is nothing to help balance of the torque created by the leg moving back, either. Nothing except the muscles in the lower 79

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back. Anyone our there have weak triceps (back of the upper arm) and a tight lower back? Don’t make your low back muscles do the work for your arms. You’ll end up with a shoulder issues and a lumbar disk degeneration. Arms swing side to side? This is an indication that your chest and shoulders have gotten so tight, the bones have rotate forward. Really pay close attention to keeping your arm swing in forward-pointing parallel lines to your body. One more thing. Bending the arms at the elbows to mimic speed and walkers actually reduces the energy you expend during a bout of walking. Race-walkers are trying to minimize their energy expenditure so they can go very fast for a very long time. Want to ramp up the kcals burned during your next walk? Exercise: Stand and let your arms relax down by your sides. Lift one arm behind you, one at a time, to see how high you can get it (don’t twist the hips or shoulders, that’s cheating). Let it drop down forward. It will swing out a little in front as you drop it, but don’t do any extra work to get it up higher. The work of your arms while walking should always be behind you. They relax when they come forward. Really working a fully extended (no bending elbows!) arm while walking is going to change everything about your daily walk. You’ll get much more out of it, including increased metabolic and strength benefits. As you become more aware of alignment, start observing the arm motion of your fellow walkers next time you have a chance. There are arms that don’t move at all, and arms that swing right to left instead of front to back. There can be one tight arm that moves less than the other, and my favorite, those trying to work their arms extra hard by holding weights. Believe it or not, arm swing is an extremely important part of a natural gait pattern, and when digitally analyzing gait, you can tell a lot about shoulder and spine injuries-in-the-making just by watching what the arms are doing.

Anatomical motions of the upper body Finger joints: Flexion and Extension Wrist: Flexion and Extension Forearm: Pronation and Supination GlenoHumeral (Shoulder): Flexion, Extension, Internal & External Rotation, Circumduction Scapula: Elevation/Depression, Retraction/Protraction Muscles of the shoulder girdle Rhomboids: Scapular rotation and retraction, and in opposite direction, generates a posterior pull on the upper spine

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Levator Scapula: Scapular elevation and retraction (with middle trapezius) and, in the opposite direction, aids in ramping the head (posterior direction) Humeral Rotators Internal

External

Subscapularis (RC)

Deltoid (Posterior fibers)

Pectoralis

Infraspinatus (RC)

Teres Major

Teres Minor (RC)

Latissimus Dorsi *(RC= Rotator Cuff) Because the bulk of our time-consuming activities (computer, driving) with our arms in internal rotation, our internal rotators are passively shortened and the external rotators are over-lengthened. This renders the entire shoulder stabilizing mechanism useless. The shoulder girdle is extremely strong (you can lift your entire weight with it!) yet extremely finicky. Because there are no real big ball and socket-type joint articulations, messing with the alignment leaves the shoulder girdle open for injury. Regular operation of the shoulder girdle in internal rotation also places high friction on the tendons of the bicep and inappropriate tension on the deltoid tendon. Issues in these areas is the shoulder’s cry for better alignment! The ultimate goal of shoulder girdle program is to increase glenohumeral stabilization by increasing muscle innervation of the shoulder girdle, and then increasing the strength to weight ration of the upper body. Visual Cues to Identify Poor GH Mechanics • “Bony Wings” • Elevated Trapezius • Sternum Bump • Macho Man Hands (GH internal rotation) • Flared Ribs

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UPPER BODY SKILL SET 1. Flat Palms– 90 degrees between thumb and middle Finger 2. Internal Rotation Assessment (“Bull Dog Test”) 3. Rhomboid Push-Up*. Can add Head Hang 4. Humeral Head Identification 5. Triceps Press-Up– Elbow Pit Forward 6. Triceps Press-Up w/Elbow Pit and Scapular Stabilization Advanced Rhomboid Push-up: Add elbow pit marker Add scapular stabilization Add rib alignment (don’t thrust ribs while in quadruped)

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Tube Press Downs: 1. Start with shoulder girdle alignment Scapulas protracted to note internal rotation Widen until bony prominence is minimal 2. Palms are up, to promote external rotation (humeral) Press down without moving scapula Keep scapula depressed (lats) 3. With humeral head in external rotation and starting from scapular protraction, begin scapular retraction Encourage “ramping up” once scapula are retracted Minimize internal rotation Minimize scapular elevation !

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UPPER BODY HANGING SERIES • Strength to lift center of mass away from ground • Strength to Weight ratio Goal of 1:1 1. Hang with lower body on ground (low bar)- palms face away

Relax Psoas/pelvis– untuck

2. Full Hang– feet off ground (higher bar)- palms face away

3. Biceps Low Pull-Up (can also be used as Easy Hang)- palms toward you

4. Pull-Up– Hold- palms toward you

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5. Pull-Up–then slowly lower body down- palms toward you 6. Full Pull-Up– from ground- palms toward you 7. Reverse Arm Stretch

Watch hips don’t drop/sag

8. Super low hang– low bar, butt almost touching ground, stretch posterior ribcage

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Foot, Lower Leg and Gait Basics “All truly great thoughts are conceived while walking” -Friedrich Nietzsche

GAIT BASICS People don’t like to walk because it’s booriiiing. But guess what? There’s nothing boring about your body, in dynamic motion, with its 200 bones, 230 joints, 600 muscles all alive with neurological connection to your brain with each step. Nothing boring about the planet you’re walking on and the bugs, animals, and people you share it with. Develop a daily appreciation for your freedom to walk, and then pass it on.

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Gait is essential to correct human function. Without it, bones do not develop correctly, joints do not articulate fully, muscles are not positioned optimally, and immunity is compromised. There are two motor skills required of natural gait (well, there are actually 600, but...). The first is pelvic list, and the second is posterior push off (hip extension.) GAIT PRACTICE Focus on one at a time for each lap 1. Feet Straight 2. Heel Strike 3. Arm Swing– elbow pit & thumb forward, squeeze elbows/wrists to sides 4. Stacked Torso 5. Ramped Head, eyes down 6. Rear Push-Off 7. Straight Leg 8. Neutral Pelvis 9. Front of foot landing– ball lands evenly 10. Barefoot– process more sensory info LOWER LEG AND FOOT MECHANICS Skill Set: To avoid unnecessary torque, all leg joints should be rotating in the plane of motion– for forward locomotion, sagittal plane rotation is the goal. 87

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Introduction of femoral internal/external rotation while standing (closed chain) using pelvic musculature (those that originate there.)

The Missing Link: The Popliteus Action: Can laterally rotate femur on the tibia, or can internally rotate the tibia relative to the femur Known Purpose: It initiates the gait process by “unlocking” the knee and beginning flexion (!!), and it aids the posterior cruciate ligament (PCL) in keeping the femur from shearing forward on the lower leg. Research: ***It is well-documented that popliteal muscle/tendon injuries occur most frequently with downhill running or walking (Garrett et al 2000, Mayfield 1977, Travell and Simons 1999). This may be due to the repetitive use of the popliteus musculotendinous unit in preventing anterior translation of the femur on the tibia, as popliteus muscle activity is proportional to increased load on a flexed knee (Davis et al 1995). Note: “load on a flexed knee” Hmmmmm… If we are constantly walking with slightly bent knees due to postural adjustments, then how fatigued is the popliteus, and what is its mechanical advantage?

Additional Gait Notes Saunders et al. defined walking as the translation of the center of mass through space in a manner requiring the least energy expenditure. They identified six determinants or variables that affect that energy expenditure (3): Variations in pelvic rotation Pelvic tilt Knee flexion at midstance* Foot and ankle motion* Knee motion 88

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Lateral pelvic displacement* These all affect energy expenditure and the mechanical efficiency of walking, and as a functional basis for understanding energy efficiency in gait, these principles have stood the test of time (13-15). These determinants of gait are based on two principles: Any displacement that elevates, depresses or moves the center of mass beyond normal maximum excursion limits wastes energy Any abrupt or irregular movement will waste energy even when that movement does not exceed the normal maximum displacement limits of the center of mass. A successful long-distance runner intuitively takes advantage of these principles. By contrast, the unsuccessful runner lumbers from side to side and lurches up and down in a vicious spiral of exhaustion followed by increased energy expenditure. Of the six determinants of gait, three(*) provide mechanical advantages that limit vertical displacement of the center of mass. The term center of mass is synonymous with the term center of gravity (CG). All determinants can be optimized through selecting the appropriate exercise prescription as extremes in vertical COM displacement have extreme energetic and metabolic costs and are oxygen expensive! Without these mechanical advantages that limit displacement, the center of mass would displace vertically 7.5 cm (3 inches) on a person of average height. Resulting from these three determinants, the center of mass is said to displace vertically only 5 cm (2 inches). Adding on Arm Swing: Until recently, reciprocal arm swing has not been included in many gait studies. Research in the last ten years has shown that people have a wide breadth of arm and shoulder girdle movements that make their gait patterns unique: • Glenohumeral extension, no spinal rotation** • Transverse shoulder girdle rotation • Lateral Arm Swing • No Arm Swing • Any asymmetrical movement **Correct Arm Swing Additional Gait Notes (cont.) Arm swing serves a dual purpose of minimizing necessary counter-torque on the lumbar spine and aiding in posterior propulsion. Working Musculature: Triceps Brachii (long head) Latissiumus 89

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Posterior Deltoid Teres Major ****The “active” phase of sagittal movements during the gait process should be in the posterior direction.**** Walking is the translation of the center of mass through space in a manner requiring the least inappropriate energy expenditure, including both during and following the walking activity. - KAB References: 1. Marks AA. Manual of artificial limbs. New York: A.A. Marks Inc., 1905:17-20. 2. Ayyappa E, Mohamed O. Orthotics and prosthetics in rehabilitation. In: Lusardi M, ed. Clinical assessment of pathological gait. Newton, Mass.: Butterworth Heinemann, manuscript submitted for publication, September 1996. 3. Saunders JB, Inman VT, Eberhart HD. The major determinants in normal and pathological gait. JBJS 1953; 35-A:543-58. 4. Perry J. Gait analysis; normal and pathological function. Thorofare, N.J.: Slack, 1992. 5. Sutherland D. Development of mature walking. Philadelphia: MacKeith Press, 1988. 6. Sutherland DH, Kaufman KR, Moitoza JR. Kinematics of normal human walking. In: Rose J, Gamble JG, eds. Human walking, 2nd ed. Baltimore: Williams & Wilkins, 1994;2:23-45. 7. Pathokinesiology Service, Physical Therapy Department. Normal and pathological gait syllabus. Downey, Calif.: Professional Staff Association of Rancho Los Amigos Hospital, 1977. 8. Ounpuu S, ed. Terminology for clinical gait analysis (Draft #2). Prepared by American Academy of Cerebral Palsy Developmental Medicine Gait Lab Committee and distributed at North American Clinical Gait Lab Conference, Benson Hotel, Portland, Ore., April 6-9, 1994. 9. Ayyappa E, ed. Words about words: the terminology of human walking, bipedal exchange. Monograph of the American Academy of Orthotists and Prosthetists Gait Society, Volumes 1-2, 1994. 10. Ayyappa E, ed. American Academy of Orthotists and Prosthetists Gait Society, Gait and Pathomechanics Syllabus, Certificate Program in Professional Development-Final Report, August 1996. 11. Finley FR, Cody K, Finizie R. Locomotive patterns in elderly women. Arch Phys Med Rehab 1969;50:140-6. 12. Ayyappa E. Gait lab technology: measuring the steps of progress. O&P Almanac 1996;45:2:28,29,41,42,56 13. Inman V. Ralston HJ, Todd F. Human walking. Baltimore: Williams & Wilkins, 1981 14. Bowker JH. Kinesiology and functional characteristics of the lower limb. In: Atlas of limb prosthetics. St. Louis: CV Mosby, 1981;261-71 15. Rose J, Gamble J. Human walking, 2nd ed. Baltimore: Williams & Wilkins, 1994.

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****The “active” phase of sagittal movements during the gait process should be in the posterior direction.**** Added Notes from Katy (in BOLD): Alignment Theory: Walking is the translation of the center of mass through space in a manner requiring the least inappropriate energy expenditure, including both during and following the walking activity. - KAB References: 1. Marks AA. Manual of artificial limbs. New York: A.A. Marks Inc., 1905:17-20. 2. Ayyappa E, Mohamed O. Orthotics and prosthetics in rehabilitation. In: Lusardi M, ed. Clinical assessment of pathological gait. Newton, Mass.: Butterworth Heinemann, manuscript submitted for publication, September 1996. 3. Saunders JB, Inman VT, Eberhart HD. The major determinants in normal and pathological gait. JBJS 1953; 35-A:543-58. 4. Perry J. Gait analysis; normal and pathological function. Thorofare, N.J.: Slack, 1992. 5. Sutherland D. Development of mature walking. Philadelphia: MacKeith Press, 1988. 6. Sutherland DH, Kaufman KR, Moitoza JR. Kinematics of normal human walking. In: Rose J, Gamble JG, eds. Human walking, 2nd ed. Baltimore: Williams & Wilkins, 1994;2:23-45. 7. Pathokinesiology Service, Physical Therapy Department. Normal and pathological gait syllabus. Downey, Calif.: Professional Staff Association of Rancho Los Amigos Hospital, 1977. 8. Ounpuu S, ed. Terminology for clinical gait analysis (Draft #2). Prepared by American Academy of Cerebral Palsy Developmental Medicine Gait Lab Committee and distributed at North American Clinical Gait Lab Conference, Benson Hotel, Portland, Ore., April 6-9, 1994. 9. Ayyappa E, ed. Words about words: the terminology of human walking, bipedal exchange. Monograph of the American Academy of Orthotists and Prosthetists Gait Society, Volumes 1-2, 1994. 10. Ayyappa E, ed. American Academy of Orthotists and Prosthetists Gait Society, Gait and Pathomechanics Syllabus, Certificate Program in Professional Development-Final Report, August 1996. 11. Finley FR, Cody K, Finizie R. Locomotive patterns in elderly women. Arch Phys Med Rehab 1969;50:140-6. 12. Ayyappa E. Gait lab technology: measuring the steps of progress. O&P Almanac 1996;45:2:28,29,41,42,56 13. Inman V. Ralston HJ, Todd F. Human walking. Baltimore: Williams & Wilkins, 1981 14. Bowker JH. Kinesiology and functional characteristics of the lower limb. In: Atlas of limb prosthetics. St. Louis: CV Mosby, 1981;261-71 15. Rose J, Gamble J. Human walking, 2nd ed. Baltimore: Williams & Wilkins, 1994.

*The ABH and the hallux adductors (ADHT & ADHO) have the greatest cross-sectional area, making them the dominant intrinsic foot muscles. 91

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Lower leg/proprioception review questions 1. What is the difference between an internal reference system and an external reference system? 2. What is the difference between kinaesthesia and proprioception? 3. How does the body sense the environment? 4. Why would the body need to sense the environment? 5. Does the body still require environmental monitoring for survival? For optimal function? 6. What are the two groups of muscles in the lower leg? 7. What characteristics must each group have? 8. What are the relative motions of each group? 9. How many muscles make up the Calf Group? 10. How does repetitive position affect the musculoskeletal system? How does repetitive position affect the sensory system? Uphill/downhill gait review 1. What muscle group (generally) is the main force generator in uphill gait? 2. What muscle group is the main force generator in downhill gait? 3. What is the main difference between uphill and downhill gait -- physics-wise? 4. What is the difference in arm swing in downhill vs. uphill gait? 5. What muscle rotates the shank relative to the femur? 6. How long will it take someone to learn to squat properly?

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Bosu Protocol

BOSU Protocol Before you get on! Because of the advanced nature of the BOSU, it’s important to teach a few basic concepts on the floor before you first get on an unstable platform. Many times, people will have to have had a basic understanding of the Essential SixTM Restorative Exercises to allow them the mobility to even stand correctly. Feel free to blend the basic exercises found in any Restorative ExerciseTM session with the first few sessions on the BOSU.

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Foot position and stance: Because the BOSU is used to flush out old motor habits and poor propriception, it is important that the stance on the BOSU be exactly right. Just like on the floor, the later borders of the foot should be pointing straight ahead. Also included in foot position is ankle width. They should be placed directly below the joints of the hip. Toe lifting without foot movement: Before having someone lift and spread their toes on an unstable platform, let them practice on the floor. When it’s time to do find the smaller muscles in the foot (intrinsic), this will come in helpful. Patellar drop: The relaxation of the quadriceps group is the simplest, objective way one can use to see if they are in knee flexion or not. Because one major hindrance to balanced muscle action is constant knee flexion, this is a great exercise to teach before one gets on the BOSU. It also makes it easy for “self-checks” when the instructor is teaching a large group. Standing sway assessment: This exercise is a great way to begin to dissipate fear associated with falling. Most people have an unreasonable fear when it comes to falling or looking foolish. This is a great way to let them be uncomfortable without creating a situation they have to worry about. And they can see how much movement they have on a stable platform! Begin the standing sway assessment with correct foot position and relaxed knee caps. Have the students note the qualities of knee flexion (if there are any), e.g. Is there a stronger ability to connect with one leg vs. the other? You can do this assessment first with the EYES OPEN, and then with the EYES CLOSED. **They should try to minimize “stable floor” sway for a few minutes prior to the first few times they mount the BOSU. BOSU Protocol Good RE prep exercises: • Calf Stretch • Pelvic List • Foot Stretch Now you’re ready to get up!

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First Exercise: BASIC STANCE ASSESSMENT Instruct foot position. Ankle joints should be on the apex of the BOSU. Students should be instructed to not look down, but forward as they stand up. Pay attention to knee shear when mounting.

The optimal body position during the basic stance is the same as on the floor: Foot position Neutral pelvic tilt (ASIS over pubic symphysis) Plumb line from ear, shoulder, hip, knee, ankle Bottom rib over ASIS Arms down by the side Erroneous muscle contraction or a inappropriate motor skill/muscle recruitment habits will coincide with the level of stillness. The less you move, the less you are contracting muscles not conducive to balance.

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BOSU Protocol EYES OPEN: Allows the student to utilize mirror and check for: Sagittal Neutral Ankle Joint (as opposed to plantar and dorsiflexion or plantarflexion) Symmetrical Foot Altitude EYES CLOSED: The first objective of closing the eyes during the basic stance is to alert the student that they have motor units that are firing out of habit, not by choice. The need for those motor patterns can be attributed to: Old injury Poor gait habits Athletic/dance background Other cultural input Shoe choice Fear The student should be instructed to identify movement patters that continue to “push” them. Those pushes are coming from habitual muscle recruitment and are happening ALL THE TIME! Regular practice of closed eye basic stance will remove those habits and allow new habits of balanced muscle recruitment to develop. Basic Stance with Head Turn Your head needs to move quickly to see what’s going on around you, yet this shouldn’t affect your stability! Try slow turns side to side without letting your body be moved from basic positioning. Second Exercise: SINGLE LEG STANCE Foot placement for single legged work is always directly on top. The ankle joint should stack directly over the smallest of the BOSUs concentric circles. The lateral border of the stance leg should be straight. Practice correct mounting habits. This exercise is used to evaluate lateral and medial muscle recruitment habits as well as femoral rotational habits. Allow the student to use the mirror to evaluate: Foot Position Neutral Ankle Joint Pelvic Rotation (try to eliminate) Floating Foot Position – should also be active, neutral ankle, everted ankle

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BOSU Protocol Adding in another level: FOOT MECHANICS The foundation of the Restorative Exercise program is restoring gait, beginning with the way the foot connects with the ground. To prevent lateral/medial foot motion when walking, the intrinsic and extrinsic foot musculature must have enough motor skill and endurance to be stable. EVERSION of the foot is a movement that is significantly under used as the ground can do most of the work while standing. When the ground is removed in walking, however, the foot cannot hold its necessary position. In all exercises, toe lifting, toe spreading, ankle eversion and individual toe isolation can be used to activate more inner thigh, medial leg, and arch musculature. Movement of the foot should not throw the center of mass off balance. As the student becomes more skillful, the movements will require finer movements and therefore innervate smaller musculature – increasing blood flow, electricity, and cellular waste removal of the legs. These two stretches for the calves and foot are great between exercises or as a wrap up: Foot/Toe Stretch Calf Stretch with Pelvic Lift

Non-Stationary Movements Always make sure to teach an exercise on the floor to demonstrate the role the floor is taking on during human movement. The non-stable surface is a great tool to bring awareness of poor motor skill, low muscle usage, and lack of stability – even in some really great athletes! Forward Bends – Great to test hamstring motor skill and strength. Weight should remain even between the feet (foot height stays the same) Foot should continue to stay flat Knee caps are always lift and lower-able (NO BENT KNEES = NO QUADS!) **Try with EYES CLOSED as an advanced exercise.

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BOSU Protocol Lateral Bending When doing a true lateral bend, the oblique muscles in the abdomen get a chance to lengthen during an eccentric movement. They will get stronger, but only if you keep the lower body stationary. This is a great exercise to work on Quadratus Lumborum motor skill. If they are firing evenly and with coordination, your lower body will retain the position taught in BASIC STANCE. Keep your feet at the same altitude. Don’t let one foot sink lower into the surface of your BOSU. Keep the pelvic from moving. *Add an everted ankle or closed eyes for greater challenge! Lateral Bending Squats Skiers Squat Again, the foot position, maintaining ankle position is key. There is also the extra challenge of not allowing the knees to collapse inward or outward. From the side view, the knee should sit over the ankle. You can cue your students to keep their feet from tipping forward into the ball. Malasana – Deep Squat This is a great pelvic opener and can be a bit easier to achieve before doing it on the floor. Ankle joints stay on the apex of the ball, a bit wider than pelvic bone-width. Easiest version: Feet have 45-degree turn out before squatting Challenging version: Feet pointing straight ahead **Keep toes lifted for greater hip/gluteal work! Skiers Squat

Malasana

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BOSU Protocol Abdominals: Ankles should stay at knee elevation Sacral Balance Again, try the sacral balance on the floor prior to coming onto the ball. Hold onto legs when beginning to allow for balance. Let go of legs to increase abdominal loading. Balance point on the floor is same on ball.

Supine Balance Pelvic and posterior ribs should stay at the same height. In both abdominal exercises, feet should be brought off the floor one-at-a-time to minimize backward momentum.

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How to Design Your Program Those who think they have not time for bodily exercise will sooner or later have to find time for illness. ~ Edward Stanley

Armed with a much better understanding of the mechanics of the body (and the mechanics of health), you should be able to evaluate your current level of human performance and either make changes or additions to your current plan. Because we are not living in “natural” times, nor do most of use live within nature, the correctives will always have a forced feel to them -- meaning times need to be made for fitting in exercises here and there and longer bouts, like 4-5 mile walks, will need to be scheduled. Many times, improving your health is not about what you add, but what you take away. Simple adjustments like removing positive-heeled shoes, or shifting your work area to one where you can stand, do not require additional time in the day. Evaluate your lifestyle and see where you can decrease negative habits to improve health.

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Suggestions: Alter footwear Add barefoot time Create standing work station Swap running or cycling time for walking Swap weight training for alignment exercise Walk instead of drive to errands less than one mile Using 25 points of Alignment The twenty five points used to improve biological function are in no particular order, meaning, it is not necessary to memorize which part of the body point #1 or #11 is associated with. You can use these points to measure yourself against optimal position. You should be able to figure out which points you are unable to “get”. These should be the highest on your list, meaning think of these points often throughout the day to make adjustments. Points that you cannot adjust into the correct position need the greatest attention when it comes to selecting exercises. Hint: Most people are unable to articulate their shoulder girdle. Design a 10-exercise series that targets the tight muscles along the backs of the legs that may be forcing the torso forward while walking and exercises to open the chest and increase shoulder external rotation. Habit to watch: Do you hike your shoulders when stressed? Spend a lot of time at the computer? Have stiff arms while walking? Note the poor habits and reduce these in conjunction with your selected exercises. Before designing your plan, you should have some goals -- something to measure your progress. Select small goals that you can reach in 90 days of constant practice. Select three goals, including how you will measure your progress: Goal 1: Measure

Goal 2: Measure

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Goal 3: Measure:

Then, select the exercises that you think will help you reach your goals! Health goals typically range from pain reduction to heart health to increased metabolism. The good news is, alignment is the key component to all of these issues! For Pain Reduction Improve vascular flow to injured area Reduce/remove friction, compression, or inappropriate torque from the area. For Cardiovascular health Improve twisting capability Rib Mobility All-over motor-skill increase (decrease blood pressure) Ability for lungs to fully inflate, chest cavity to have correct pressure Identify isolated mechanic/disease issues (Bones, feet, pelvic floor, respiratory, etc.) Find exercises that improve this area specifically

Why should everyone start with 1A/Gait Basics? These points/exercises target the gait related habits we have acquired as a culture – these might not be the essentials at another place or time, but they work *today*. They are not “fine motor skills”. They target large muscular areas, giving a clear demonstration how poor our mobility is at the MAJOR axis of the body. • They are fairly simple to perform, breeding a psychological success pattern. Pain Reduction • Identify missing motor skills in the area • Prescribe exercises that enhance blood flow and waste removal • Identify contributing gait/postural habits Cardiovascular Health • Assess twisting ability – prescribe accordingly • Increase respiratory ability: -rib (intercostal) mobility 102

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-Humeral external rotation Increase motor skill between humerus and scapula • Remove dangerous geometrical changes -Cervical extension=plaque formation close to brain -Ramping-up -Rhomboid push-ups to allow levator scap. to pull cervical spine posterior • Remove other geometrical changes -Hips (flexors) Specific Issues • Bones -Weight bearing, balance, site-specific • Neurological -Spinal curvature -Over all flow increase to develop motor units and grow neurological tissue • Respiratory -Ribs, chest opening, thoracic curvature • Pelvic Floor -Sacral stability=glute strength -Posterior driven gait required! -Hip Opening • Weight loss -Assess general mobility=BMR -Increase overall mobility=Increase BMR Greatest motor skill missing in excessive weight Review questions - osteoporosis 1. What is bone remodeling? 2. What are the cells involved in bone remodeling? 3. What is the roll of each of these cells? 4. What is the difference between osteoporosis and osteopenia? 5. What areas of the body are the most likely to develop bone mineral loss? 6. Why does bone loss in these areas "make sense"? 7. When does bone density reach its peak? 8. How would one maximize their peak bone density? 9. How could one maximize their bone density once they have passed their peak time? 10. What are two "force dampeners" that could be present in someone's walking habits?

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Becoming a Restorative Exercise TM Specialist

Once you have completed the personal alignment program, you have the option of continuing on to become a Restorative Exercise SpecialistTM. The Restorative Exercise Specialist is a 200-hour course. The personal alignment component includes: 42 hours of academic content (upper, lower body, core, etc.) and: No More Kegels Webinar (6 hours) Female Physics Webinar (6 hours) Psoas Science Webinar (3 hours) In addition to the 57 hours of recorded programs, there is also approximately 10 hours of video content (on the DVD programming) that you are responsible for watching (and eventually mastering) as well.

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Additional hours: 15 hours of academic homework time for the entire program -- it may take you slightly more or less time. There is 15 hours of self-exercise practice time allotted to this course. There are exercise components imbedded in the online material - these should be repeated to master the motor skills presented. At the completion of the personal alignment course, you qualify to receive a certificate of completion. Please contact the office at [email protected] to request your certificate. ACQUIRING THE RESTORATIVE EXERCISE SPECIALIST-CERTIFIED PERSONAL TRAINER CERTIFICATE (RES-CPT) Should you wish to go on to the professional program, these are additional requirements. 1. Attend one “certificate” week* at the Restorative Exercise Institute ! Includes 5 private sessions, 15 classes (or more, if offered), one 1A session, two ! 2-hour pre-test study groups (25 hours) 2. Additional 10 hours of online exercise sessions from RExI to be “mastered” (allow 30 hours) 2. 10 Practice hours (documented teaching to friends/family) 4. 10 Intern hours (documented teaching clients under current RES or other health professional) 5. Workbook Study (Content review), 10 hours. 6. Project, 15 hours. The graduate will submit a written project that demonstrates their ability to apply biomechanical principles and/or exercise prescription to different populations. 7. Practical Exam (pass/fail) 8. Written Exam (pass by 80%) Additional cost of $950 for certification week, including all courses, sessions, and testing as well as additional online classes.

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Once you enroll in the personal alignment program, you will be notified of groupcertification weeks or feel free to contact us to arrange individual dates at [email protected]. Your certification is valid for two years and is renewable with 90 hours of alignment exercise/coursework (every two years) in various formats. This is to ensure that RESCPT are up-to-date on the latest publications/messaging/science presented by the Institute. For more CEU information, please contact [email protected].

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