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"Shoulder Pain? The Solution and Prevention" - A Book Review

John M. Kirsch, M.D., has practiced medicine for over 40 years and is a board-certified orthopedic surgeon. He served as a flight surgeon in Vietnam, and also worked with the Louisville Hand Institute. After a few years of using conventional surgical and rehabilitative techniques to correct shoulder injuries, Dr. Kirsch (accidentally) found a very simple solution that helps restore joint function, reduces and often eliminates pain, and restores quality of life. He has used this technique for nearly 40 years on himself and his patients to often avoid the need for risky surgery. The third edition of this book was written by Dr. Kirsch in 2012; I believe it was updated in 2019, but this was the only copy of the book that I was able to locate. What you'll find is a book full of useful information that is easy to grasp, along with anatomical pictures and illustrations that help us to better understand a very complicated joint.

We learn that the shoulder joint is primarily a ball and socket joint, or what is more specifically known as the glenohumeral joint. This is where the head of the humerus (upper arm) connects to the glenoid fossa (indentation) of the scapula (shoulder blade). However, the shoulder also includes acromioclavicular (AC) joint, which is where the scapula and clavicle (collar bone) meet. When football quarterbacks get diagnosed with a separated shoulder as a result of a hit, this is usually where it occurs. The acromion process, a part of the scapula, is a component of what is called the coracoacromial arch (CA arch), which rises over the shoulder joint and sits just above the rotator cuff muscles and the coracoacromial ligament (CAL). The artists' renditions and computed tomography (CT) scans show this beautifully. Due to the effects of time and gravity, the space below the CA arch can narrow, causing impingement, pain, and fraying of the rotator cuff muscles and tendon, as well as the condition known as frozen shoulder.

Dr. Kirsch recommends hanging suspended from a straight bar with your palms facing forward. This helps to reverse the effects of aging and gravity by opening up the space below the CA arch, and now that we know more about shoulder anatomy this makes perfect sense. The author notes that when we were children we did things like climb trees, swing, and hang with our arms overhead, but that we do less of that as we get older. Regularly hanging suspended from a high bar can help to relieve many shoulder issues, even if you have a rotator cuff tear. As the author explains, "95 percent of rotator cuff tears are caused by the subacromial impingement syndrome (SIS). This condition is caused by tightness or contracture of the arch of ligament and bone that covers the upper arm and rotator cuff tendons that lift the arm. The tightness or contracture of the CA arch causes painful and destructive 'pinching' of the rotator cuff. The cause of the contracture of the CA arch is unknown, but most likely related to disuse and gravity." CT scans and illustrations in the book show the difference in the CA arch when at anatomically neutral and hanging positions.

How can we implement this hanging exercise into our routine? Any secure straight bar will work, even the portable ones that you can hang in a doorway. The Nautilus Multi-Exercise machine that we have at Total Results works perfectly, but there are several less cumbersome options you can use at home. Dr. Kirsch recommends starting off by hanging for about 30 seconds a few times a day, depending on the severity of your shoulder infirmity. I must warn you that you will experience shoulder discomfort as you perform the exercise, but that is not indicative of further injury. As improvement occurs, you can decrease frequency. It's a good idea to start out with part of your body weight supported, and then gradually work up to where you are hanging completely suspended. Getting safely loaded into and unloaded out of the exercise is absolutely critical. Never jump to reach the bar or load yourself abruptly - this will significantly increase the risk of injury. Depending upon the height of the bar, use a step stool or ladder to load and unload. Try to avoid excessive swinging, although a little rocking should pose no problem. If you have trouble maintaining your grip, I would advise investing in a set of lifting hooks. Finally, maintain proper neutral position of the head and neck during the exercise.

This book is written for the layman, not the professional, and Dr. Kirsch does a good job of keeping things simple and not getting overly technical. If you're not interested in the anatomical descriptions, you can simply skip ahead to how to perform the hanging technique. I am typically against stretching as a means to prevent injury, and I maintain that belief in most instances due to concerns over joint laxity, but as we see in the book many shoulder problems are a result of excessive tightness, so I believe the reasoning here is sound. Contraindications for performing this technique are if you have unstable or frequently dislocating shoulders, or are suffering from osteoporosis. Another thing I like about this book is that Dr. Kirsch goes to great lengths to avoid having to perform surgery, and that he is honest about its efficacy. That means a lot, considering he is a surgeon by trade. Where the author and I part company has to do with the strength exercises he has chosen. I am not a proponent of using dumbbells in most cases, since it is much more difficult to control independent movement arms and impossible to increase weight in small increments. Dr. Kirsch does not understand the exercise principle of inroad, instead recommending an arbitrary amount of repetitions. Furthermore, there is nothing discussed about speed of movement or the dangers of excessive force. This is the primary cause of injury during exercise, and it is ignored by the author. Aside from that, I agree with the basic premise of the book.

Whether your shoulder problems are recent and due to a singular event, or are chronic and a result of overuse, I believe that this hanging technique can make significant improvements in shoulder function, pain, and quality of life. This is a passive exercise that requires very little effort or time on your part, and can pay significant dividends in short order. It is certainly a more desirable alternative to surgery and lengthy rehabilitation.

Posted September 30, 2022 by Matthew Romans

The Value of Regularly Testing Yourself

We live in a world of relative abundance compared to our ancestors of just a couple of generations ago. Even though we face some uncertainty in regard to inflation, our energy resources, and supply chain, in contrast to what Thomas Hobbes said in Leviathan, life is no longer necessarily "solitary, poor, nasty, brutish, and short." Our life expectancy, in spite of skyrocketing rates of chronic disease, is also higher than a couple of generations ago, although it has dipped slightly since Covid. People are living longer and have more leisure time than ever before. Life is not nearly as difficult for us as it was for those of the G.I. generation. Modern conveniences are great; believe me, I wouldn't want to live in a world without air conditioning and indoor plumbing. However, this easier life has dulled us and made us less resilient. Now all that we have to do is press a button on our phone and whatever we want (especially food) shows up on our doorstep in mere moments. This can do a number on us psychologically, much like what happens to lottery winners with sudden unearned wealth.

How can we maintain proper perspective, enjoy the good things in life, and still maintain mental toughness? Test yourself. Many of us don't challenge ourselves on a regular basis; we're just trying to get through life the best we can. I suspect that a good number of Americans are content with their current capabilities and don't regularly do difficult things to find out exactly what they're made of. I believe this is a huge mistake. Each one of us is capable of accomplishing great things if we have the right attitude and mindset. Performing tasks that are demanding will help you to stay mentally and physically tough, and will also create a huge sense of accomplishment when they are completed. Nobody wants to find themselves in dangerous or truly adverse circumstances, but if you do hard things when the stakes are low, you will build up the ability to deal with difficulty if that time eventually comes.

What are some ways that you can test yourself?

Practice intermittent fasting. Many of us think we'll starve if we don't eat every few hours. This is utter nonsense. Older generations ate very sporadically, due to a multitude of factors, and managed to not only survive, but thrive. Try a 24 hour fast just for the challenge. I guarantee you will learn something about yourself and you'll come out better on the other side. Stay metaphorically hungry.

Read a challenging book. Step out of your comfort zone a little bit. Sometimes a book's genre or subject might not initially be attractive to you, but as you read further you end up being pleasantly surprised. Other times, it was just as bad as you initially thought, but there is value in sticking it out until the very end. Either way, it might just open up your mind to something new.

Exercise. Pursuing a meaningful metabolic experience is not designed to be fun. It is hard work that involves discomfort and occasional mental anguish. How you mentally approach a Total Results workout makes all the difference in the world. If you go into it with fear and anxiety, it will be a big hurdle to overcome. If you embrace the challenge, realize that the workout will be brief, and give your best effort, it will be incredibly rewarding. I have not experienced too many greater feelings of accomplishment than the one that occurs after an outstanding workout. Doing this every week maintains good habits and keeps you mentally tough.

Take a cold shower. I learned this from reading former Navy SEAL Dan Crenshaw's book Fortitude. It sounds like a crazy idea, but if you have ever taken a cold shower in the middle of January, you know it's typically an unpleasant experience. When you get up early in the morning and you're still shaking off the cobwebs of sleep, the cold water hits you like a ton of bricks. After the first few minutes, it gets easier. The way I look at it, you're starting the day off by overcoming some adversity. You can then face the rest of your day with confidence.

Sharpen your focus on an important task. Focus seems to be in short supply these days, with the multitude of electronic screens we stare into and the general approval of the concept of multitasking. It's much harder to focus on one thing and do it well rather than have pots going on multiple burners at the same time. Anything worth doing is worth doing right. Concentrate on completing one task to the best of your ability and don't worry about anything else until that is done. Lock your phone in a separate drawer or room until you have finished what you started. This is not easy, of course, but the question is how badly do you want it?

To paraphrase author Ryan Holiday, if you can't do something challenging when no one is watching, how will you do it when it truly counts? Regular challenges and personal tests are what keep us moving forward, give us perspective, and keep us humble. If you do these things when the stakes are relatively low, you will be ready when the ante is upped. Find out what you're truly made of, and you will be on the road to knowing yourself and truly finding inner peace.

Posted September 16, 2022 by Matthew Romans

Six Factors of Functional Ability

One of the logical goals of pursuing a comprehensive exercise program should be to be able to perform daily activities (and other physical tasks) safely and with greater ease of effort. Dr. Doug McGuff has talked about something called maximum physiological headroom, which is essentially the difference between the most that one is capable of doing and the least one is capable of doing. When the most and the least are equal, death is the result. There are six factors of functional ability that determine how well we perform physical tasks of varying degrees of intensity. Two of these factors are genetically predetermined, four are within your power to improve, and one is specific to the nature of the activity you are pursuing. Ken Hutchins discusses these six factors in "The Renaissance of Exercise", a 2011 updated version of the original Super Slow Technical Manual, and I have found that most exercise enthusiasts and "trainers" are either grossly unaware of these factors, or lack the ability to articulate them. I mention the factors here because they provide some context to the Total Results exercise philosophy.

Neurological Efficiency. This is the percentage of muscle that can be contracted in a maximum effort, and usually falls somewhere between ten and forty percent. This is genetically predetermined by birth and cannot be changed by exercise. If an exercise subject has difficulty maintaining a smooth movement and performing subtle turnarounds, it is likely that they are neurologically inefficient. Such clients can still make considerable physical improvements but may progress more slowly.

Bodily Proportions. These include bone length, muscle belly length (between tendons) and tendon insertion angle. One's body proportions often play a big role in what sports or activities a person decides to pursue. Think about former Olympian Michael Phelps: he has long arms, long legs, big hands, and wide shoulders. You probably couldn't pick a better prototype for an elite swimmer. There are numerous other examples of top-echelon athletes, but his example really sticks out. Bodily proportions are also genetically predetermined.

Cardiovascular Efficiency. This describes how effectively the heart, lungs, and blood vessels transport nutrients to the working muscles and remove waste products from them. Steady state (largely aerobic) activity is relatively inefficient for accomplishing this, and carries with it a high risk of repetitive stress injury. Improving cardiovascular efficiency is best accomplished by performing intense exercise for the skeletal muscles (a Total Results workout). Remember that the cardiovascular system can accomplish nothing on its own; it needs mechanical loading of the skeletal muscles. If there is a greater demand placed upon the muscles, then the aforementioned structures will have to work harder in order to keep up, thus creating a reason to adapt.

Skill Proficiency. Improving your ability to perform certain skills or tasks requires regular repetitive practice of those specific movement patterns. If you want to get better at tennis, practice the shots that the sport requires in conditions that are as close to or identical to a competitive match. The same is true for playing a musical instrument. If you are giving a piano performance on a Steinway baby grand piano, it doesn't make sense to practice on a Casio portable keyboard. This allows your muscles to function as efficiently as possible when performing these skills.

Flexibility. I believe that too much importance is placed on this factor. Flexibility can be improved to a certain degree, but it is highly overrated in my opinion. Many people do unsafe things to improve flexibility and often get injured in the process. Things like ballistic stretching, PNF (proprioceptive neuromuscular facilitation) stretching, and other types of flexibility training needlessly raise the risk of injury with very little reward. Hockey goaltenders and ballerinas use extreme degrees of flexibility, but this is something that is required to excel at their endeavors. This is not recommended for regular people; all one needs is a functional range of motion for everyday living. For my money, flexibility is most safely enhanced by performing proper strength training through a safe and pain-free range of motion on our Super Slow Systems and Med-X machines.

Muscular Strength. Skeletal muscle is the one type of muscle tissue in our body over which we have volitional control. Muscles produce force to enable movement. It should surprise nobody that the main reason for a loss of independence by the elderly and infirmed is a decrease in muscular strength that comes with age. Working to increase strength has both a direct and indirect effect on other physical improvements (fat loss, insulin sensitivity, resistance to injury, etc.) because all of the body's other subsystems are subservient to the skeletal muscles. Total Results exercise is the safest and most efficient way to improve one's muscular strength.

When we talk about functional ability, please do not confuse that with so-called "functional" training. Functional training involves performing a series of everyday movements with added resistance. Not only is this practice extremely dangerous due to high forces, it completely violates principles of motor learning. It's also important to differentiate neurological efficiency from neuromuscular adaptation. As Ken Hutchins says, "This (neuromuscular adaptation) is not in the sense of the all-out effort, but in the recruitment of motor units as the muscle progresses through a set of multiple repetitions." While your distribution of muscle fiber type is genetically predetermined, you can improve how efficiently each fiber type is recruited during the course of exercise.

Understanding the factors of functional ability can give you a better sense of how your body works, and what can and cannot be improved through training and practice. Much of what is required to perform at a high level every day and for many years to come is within your power to change. I often go back to what the Stoic philosophers have said for a couple of thousand years, and that is to understand what you can control and what you can't. Great physical and mental improvement can be made if you are willing to put in the work and apply the knowledge passed along to you by your instructor. We want to see you succeed, but it is largely up to you.

Posted September 02, 2022 by Matthew Romans

Don't Expect Miracles, Expect Your Very Best

People undertake an exercise regimen for a variety of different reasons. Some may have recently had a health scare, and are urged by their physician to become more physically active in order to avoid a repeat performance. Other people do it for purely cosmetic reasons. There may be a class reunion or a wedding coming up, and a fitness regimen is a means of (ostensibly) shedding those unwanted pounds or fitting into that dress. Another class of individuals begin exercising simply because they want to get more out of life. This may entail being healthy enough to play with their kids/grandkids, travel, and be more of a participant in life. No matter what the reason is for taking an interest in exercise, unfortunately most people lack the knowledge or the fortitude to make sustained meaningful progress.

As the wise philosopher Ozzy Osbourne once said (back when he was still capable of putting a sentence together), good intentions pave the way to hell. Many believe that they are doing this for all the right reasons, but don't truly understand how challenging it is to make meaningful physical change happen. It could be that they have a low tolerance for physical discomfort, have been given bad advice, or a combination of both. They may not be willing to make the necessary lifestyle adaptations or devote the proper focus that creates good habits. Consequently, when they don't see immediate results they either take shortcuts or give up altogether. Take a look at a Planet Fitness parking lot in early January, and then go back in early March; you'll likely see a stark contrast. Some will resort to gimmick diets that do the work for them, but once they get off the diet they are typically right back where they started. Gastric bypass and/or other forms of elective or cosmetic surgery are popular, but they carry an inherent risk, are quite restrictive, and often lead to a lapse in one's lifestyle.

There is no such thing as a magic pill or a magic cure. If something seems too good to be true, it probably is. The commercial fitness industry is full of the latest hot trends that ultimately prove to be a waste of time and money. What most traditional doctors won't tell you is that the majority of chronic disease occurs as a result of poor lifestyle choices. Yes, some people have genetic predispositions to conditions like cancer, heart disease, and obesity, but a predisposition is not a guarantee. You have no control over your genetic makeup; after all, you can't pick your parents. However, you can play the hand of cards that you are dealt and achieve your very best self within the constraints of your genetic blueprint.

It all starts with the self, and sometimes this requires some introspection and a tough personal assessment. What is it that you want to accomplish and how hard are you willing to work to achieve it? Identify the things in life that are within your control, as well as the things that you cannot control. It is within your power to set regular bed and wake up times, to incorporate stress management techniques, and to eat a nutrient-dense diet consisting largely of single-ingredient whole foods. Do you have any control over the traffic during your daily commute? No, but you can control how you react to it, and you can also leave a little earlier so that you have more of a margin for error. Are you willing to commit your time and resources to starting a comprehensive exercise program and giving your best effort every time out? If so, then Total Results is the place for you.

Our program is not predicated upon fads or gimmicks, it's based on science that goes back more than four decades. It's not a social club, and we don't have bright lights, mirrors, music, or any of the other distractions that you see in commercial gyms. What we have is a clinically controlled environment with the finest equipment in the industry, and over twenty years of instructional experience in working with a variety of different populations. Regardless of your physical limitations (if any), we will help you to increase your strength, flexibility, and cardiovascular and metabolic conditioning, as well as resistance to injury. Fat loss is greatly aided by regular strength training, but is largely a dietary issue. We can teach you to make better food choices as well as incorporate time-restricted eating, which is a great asset in warding off chronic disease. Not everyone who exercises at Total Results will look the same, but everyone has the potential and the ability to be their best self. Every client has access to the same quality of instruction and equipment at our facility, but the best results occur when you make this a priority, focus, and work as intensely as you can in each workout. Don't put any undue pressure on yourself, but giving your best effort should be important to you. It all starts inside you.

Don't expect to look like the celebrities or athletes you see on TV or the internet. Chances are, they have been surgically or chemically altered. In fact, does anyone else find it strange that Dwayne (The Rock) Johnson is physically larger and leaner at the age of 50 than he was when he was a professional wrestler over 20 years ago? Something doesn't add up. Have realistic expectations and celebrate the victories of doing the right things every single day. Small wins add up to big results over time, just like the law of compounding interest. You should not expect miracles, but expect to do your very best, because that's all you can do. Anything worth doing is worth doing right. Let Total Results show you how.

Posted August 19, 2022 by Matthew Romans

"The Lethal Dose" - A Book Review

Dr. Jennifer Daniels is a former board-certified family practice physician originally from upstate New York. She received her undergraduate degree from Harvard, and then earned both her medical degree and an MBA from the University of Pennsylvania. Dr. Daniels first experienced some misgivings with traditional medicine as early as medical school, but pushed forward to complete her education and transition into residency. After practicing medicine for a decade, she eventually became disillusioned with the establishment medical system and started using unorthodox methods of patient care. Subsequently, her license to practice was lifted by the medical board for refusing to prescribe what she believed were unnecessary and dangerous medications. Amazingly enough, she was also placed on the "Do Not Employ" list, meaning that she could not get a job in the U.S., and the federal government put her on the Terror Watch List. Dr. Daniels was forced to flee to Panama, simply because she had reservations about prescribing lethal medications. In order to educate the public and tell her story, the good doctor published "The Lethal Dose" in 2013.

The term lethal dose is defined as, "the amount of something, usually a medication or a chemical that causes death." Something called LD 50 is the dose of a drug that kills half of those that take it. Dr. Daniels first learned about these terms in medical school and asked if there was such a thing as LD 0, meaning that the dosage of that particular drug didn't kill anybody. She was told that no such thing exists. A sobering thought. What I find infuriating is the fact that over 100,000 people die each year taking the prescribed dosage of medication. Yes, you read that correctly. These are people that die simply following the instructions of their physician, someone they think they can trust. The author details a personal experience when she was a resident where a patient had been overdosed on heparin, which is a blood thinner. The nurse had made a mistake and given the patient eight times the drug at four times the rate, which caused the patient to start bleeding out everywhere. After the mistake was caught, Dr. Daniels stopped administering the drug immediately, but was overridden by the senior doctor and told never to stop administering a drug, ever. Consequently, the patient needed a transfusion of 26 units of blood and bled into his eyeballs, causing him to lose his eyesight, and with it, a promising dental career.

If there is one thing that provides details as to the fundamental problems with mainstream medicine, look no further than the term standard of care. This is defined as "treatment that is accepted by medical experts as a proper treatment for a certain type of disease and that is widely used by healthcare professionals." Dr. Daniels tells us that doctors cannot ignore the standard of care, for fear of losing hospital privileges, the loss of income, and also malpractice lawsuits. Ironically, there are only three entities that can write the standard of care. These consist of drug companies, insurance companies, and hospitals. Not coincidentally, these are the three entities that profit the most from the way the system is currently constructed. The worst part is that the two groups that should have the most input as to standard of care, do not have a say in the matter. These are doctors and patients. Notice a problem here?

Dr. Daniels describes her residency training as a tremendously difficult period, working 90 hour weeks and being sleep-deprived much of the time. She was not allowed to use the word "cure" when working with a patient, but rather "treat." The author goes on to say, "We were not allowed to offer any solution or thought that was outside of something that would profit the drug company or hospitals." That means natural therapies or non-drug alternatives were out of the question, and it is far more lucrative to treat a patient indefinitely with some drug which may or may not be effective than it is to cure them without side effects. I also found Dr. Daniels' thoughts on antibiotics very interesting. It has long been my belief that modern internal medicine has devolved into asking for a prescription for an antibiotic to cure a sniffle. With regard to antibiotics, Dr. Daniels offers these thoughts: "So did antibiotics ever save a life? After 20 years of prescribing and witnessing the use of antibiotics, I have observed no evidence of that (her emphasis). I have to be honest, and the truth is that antibiotics account for as many as 63,000 deaths per year. The deaths from bacterial infections are almost always from the organisms created by antibiotic use. So there's no question in my mind that antibiotics are not lifesaving. A lot of those deaths are from pneumonia infections caused by these resistant bacteria (her emphasis)." Considering the establishment viewpoint on drugs, an alternate opinion should at least be discussed.

Even during her family practice days, Dr. Daniels would prescribe natural remedies and see patients respond rapidly. These remedies included alternative natural herbs, ointments, and even writing out diet suggestions on her prescription pad for patients to implement. These natural remedies can work for a variety of ailments, including digestive difficulty and hot flashes. The good doctor stresses the importance of drinking more water, eating more "live" food (food picked out of the ground), and incorporating movement and exercise into your lifestyle. Even though she technically doesn't practice medicine any more, she has helped many people in Panama with some simple strategies and hasn't charged anyone a dime.

I found the book to be riveting, and tore through it in a couple of days. It is only 85 pages, including endnotes, but a lot of information is packed into those pages. Dr. Daniels writes in an engaging style, and having seen a couple of her videos I can tell that she writes like she talks. My only complaint is a couple of typos that I found, but that's typical in a self-published book. Frankly, I doubt this book would have come out through any of the establishment publishing houses, given the subject matter. I believe that Dr. Daniels is a hero worthy of our everlasting respect and gratitude for sharing her story and having the courage to walk away from medicine rather than sacrifice patients by practicing in a corrupt bureaucratic system. We all owe her a debt of thanks.

Posted August 03, 2022 by Matthew Romans