Reclaiming Physical Fitness After the Pandemic

The past year has been hard in many ways, and psychologists, social workers and other mental health providers have been busy helping people through it all. Fortunately, insurance companies have been supportive of this important service, and have waived deductibles, helping make mental health services accessible even to those experiencing financial hardship.

But our physical health has been suffering, too, and most people have not received any support with accessing services to help them with this. In a country troubled by obesity and an epidemic that puts overweight individuals at a significantly increased risk of serious illness from the virus, this is quite unfortunate, to say the least. Many, if not most, conditions worsen when our levels of physical activity decrease, and so does our mental health and wellbeing. And while it is perfectly possible to maintain excellent physical conditioning while avoiding public gyms, it has been hard for most people to figure out exactly how to go about it.

The dilemma is that when we want to start exercising again, we will be doing so with bodies very well adapted to sitting, and perhaps walking, and very poorly adapted to physical exercise, and for far too many people injuries will follow.

An abrupt return to activity may be even more risky for certain individuals. This includes those with either less muscle mass to begin with, e.g. the elderly, or those that need high-functioning musculature even more than others, such as individuals with hypermobility syndromes or high-level athletes.

One of my favorite Swedish sayings goes something like this: “(There’s) nothing bad without a good.” The pandemic is no exception, and one of the positives I, like many others, have experienced is the realization that you don’t really need any classes or expensive gym memberships in order to give your body the exercise that it needs to be healthy and resilient.

Our bodies evolved in a world where they simply had to move a great deal in order to procure food and build shelter, and therefore we developed a genetic dependency on movement in order to stay healthy. The CDC recommends at least 150 minutes a week of moderate intensity activity such as brisk walking (that’s almost an hour of walking three days a week) and at least 2 days a week of activities that strengthen muscles (and if you decrease the frequency of your resistance training you need to increase the intensity or volume per session to receive these results).

The CDC doesn’t go into the specifics of the concept of ‘strengthening.’ We understand this to be ‘strengthening muscles,’ but how do we best accomplish this? Are all muscles created equal? Why do we need to strengthen muscles anyway?

To understand the musculoskeletal system of the body without bothering with years of anatomy and physiology, think of a tree. The trunk is thick and sturdy, while the limbs provide movement. Like the tree, we, too, have a trunk that needs sturdiness, or stability, as we like to call it. We need to be able to push, pull, bend and lift with our arms and legs without the force of our movement forcing the spine — the support beam of our trunk — to move too much. You see, just like the tree, our trunk is designed to be stable while the limbs are designed to move. Without this acquired stability, for bipedal animals like us, the trunk, and especially the spine and its soft-tissue structures, is at risk of injuries, both chronic and acute. Unfortunately this type of dysfunction is so common that the symptoms of it, be they acute bouts of sharp back pain every once in a while, or gradually deteriorating joints, are considered normal and unavoidable, and therefore we often don’t pay sufficient attention to the need for rehabilitation that such symptoms may signal.

The muscles that provide said stability to the trunk (as well as the shoulders, neck and hips that also require some stability) are a bit different from the muscles you may be used to thinking about. They are not quite okay with the CDC guidelines alone, and need some movement throughout the day to stay strong and active. Compared to movement producing muscles, they are relatively weak, but have great endurance. The biceps of the arm (the muscles that bend the elbow) can become quite strong with consistent training, but they fatigue easily. The muscles that support the spine, e.g., the multifidi, do not possess such strength, but they can work diligently all day long. And therefore they need to.

What is the practical implication of all this, you ask? These stabilizing muscles make biomechanically correct movement possible, protect our joints, and give us the endurance to remain upright without discomfort. They prevent back pain, knee injuries and ankle sprains and keep all our joints safe. Just like developing babies, adults, too, must develop their strength and skills in the right order to ensure a safe return to, or maintenance of, physical exercise. In order to do this, we must acquire either at least a rudimentary understanding of how and at what pace to progress, or rely on someone that can help us do this.

This type of help is exactly what physical therapy offers. A gradual process of “building the body from within” (the stabilizing musculature, in the trunk recently popularized as the somewhat amorphous concept of the “core,” lie deep in the body, right next to joints), based on the patient’s starting point and needs, is important, and the closest we can get to guaranteeing success.

The “boom and bust” cycle we otherwise tend to experience when all too eagerly rushing into a new exercise regime, only to experience injury and pain, is not only potentially harmful to our bodies, but may also act as a deterrent for future attempts at fitness and health.

If you want to reclaim physical fitness, but don’t have access to a physical therapist to safely guide you as you embark on this process, think back to the tree metaphor to help you understand the role of stabilization. Let go of any mental images you may have of exercise as being all about lifting dumbbells or sweating away on an exercise machine. Instead, think about the deep stabilizing muscles first. Don’t worry, you’ll get to the heavier weight lifting or spinning soon- this is all about preparing you for whatever type of exercise you, ultimately, would like to engage in!

You will find several simple, safe and effective stabilization exercises in the instagram feed here. Youtube can be a treasure trove of information, but any forum that has no requirements for credentials or proof of expertise will of course also be a wellspring of misinformation, so tread carefully if you’re setting out on your own.

After working on stability, how will you eventually know that you are “stable enough” to continue with strengthening of the more peripheral parts of your body? The most important question is “stable enough for what?”, as the body of a circus artist or dancer of course has very different requirements from that of a daily walker. That said, you should be seeing significant progress in your ability to perform stabilizing exercises correctly, and at this point you can add the challenge of an easier form of your desired type of exercise to see you are indeed able to maintain the stability of your trunk. You might, for example, be interested in lifting weights, and feel like you’ve made good progress with your stabilizing exercises. Try standing and lifting a lighter weight, and observe yourself in a mirror, to see if you’re able to perform the movement without your back swaying, your knees buckling or any other compensatory movements. Try rowing on your rowing machine and see if you can move from your hip and shoulder joints and keep your low back still. Try going for a walk and see if you can feel your arms and legs swing while your trunk stays relatively stable, but not stiff. Even standing still while reaching for an object on a high shelf requires stabilization. Can you do it without leaning back from your low back or bending at the knees?

As you increase your level of activity, impatience is your worst enemy. It takes a certain amount of time for the tissues of the body to recover from and adapt to exercise, and the older we get the longer it takes. Give your body the time it takes to build strength onto the stability you’ve acquired, and if you mess up and let impatience get the best of you (I know I have!) don’t worry. Just relax, regroup, and start again, a bit more slowly this time. “Start low, go slow” is always the recipe for success when returning to activity or increasing your activity level.

Having trouble getting used to exercise is not about there being something wrong with your body, but with your approach, and the latter can easily be improved.

I’ve cautioned you to start up slowly, so next I’ll tell you to “always be careful — only lift light weights and not aim too high,” right? “Act your age lest you get hurt.” Let’s be very clear: this is not the path to success. Building a stable (pun intended) foundation is about being able to progress, to challenge yourself, to aim higher than you’ve dared to before. It’s about challenging preconceived notions, whether they’re your own or those of our culture, of what you should be able to do, whether it’s due to your age, a diagnosed condition or a long-standing habit.

Whether it’s a house, a relationship or your physical health, the strongest structure rests on a stable foundation. The same physical foundation will allow you to enjoy the experience and wide-ranging physical and emotional benefits of exercise for as long as you live, and help you live longer, too, for that matter.

Here’s to great beginnings and lifelong healthful habits!

Lilian Holm, PT, DPT is a physical therapist in private practice in Evanston, IL. Find her at https://www.lilianholm.com/ and on social media.

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