Located in Sterling, VA (703) 421-1200

July 2021

"8 Steps to a Pain-Free Back" - A Book Review

Esther Gokhale is an acupuncturist and yoga instructor who studied biochemistry at Harvard and Princeton Universities, and also learned acupuncture at the San Francisco School of Oriental Medicine. She grew up in India, and during her youth she helped her mother, who was a nurse, treat abandoned babies that were waiting to be adopted. Gokhale published "8 Steps to a Pain-Free Back in 2008, as a way to put into book form the postural teachings that she has been using with clients for many years, many of whom work in Silicon Valley. We have had a copy of this book sitting in our office bookshelf for many years, but only recently did I decide to read it cover to cover. This book will change the way you think about and approach how you sit, stand, walk, and even lie in bed.

The beginning part of the book lays the foundation for the lessons that come later. There is a great description of how a healthy spinal column should look. The vertebrae should be "stacked" upon one another with a minimal curvature, rather than the S-shape we have come to accept. In fact, there is an illustration that contrasts a spinal column as detailed from a 1911 anatomy book with a spine taken from a book published in 1990. The difference is striking; the more recent illustration has a much more elaborate curve than the illustration from the early 20th century. In a healthy spine, the pelvis should be anteverted (tilted slightly forward) in order to maintain the proper wedge shape of the disc between L5 and S1. As Gokhale says, "The ideal shape of the spine is a gentle, elongated curve, not an exaggerated "S" curve. Pronounced curvature should only occur at L5-S1 at the base of the spine." Exaggerated spinal curvature can distort and compress vertebral discs, which may lead to numbness, pain, and injury. One interesting element that I had not considered was how cultural norms affect the construct of what is considered good posture. This can be understood by looking at pictures in the book showing models and advertisements, clothing, shoes, and even how modern furniture is designed. You can see the difference when you look at images from indigenous cultures or even pictures of Americans from the late 19th or early 20th century. A great number of these photos show far better posture than many of us currently display.

The first of the author's lessons details what is called stretchsitting. During this lesson, we learn the proper way to sit, how to lengthen your spine (which eases compression of the vertebral discs), and how to perform shoulder rolls in order to remedy hunching. This involves shrugging your shoulders and then rolling them comfortably backward and forward. As Gokhale describes, "Shoulder rolls influence the architecture of the area just beneath the pectoral muscles. This area, called the brachial plexus, is a major thoroughfare for nerves and blood vessels supplying the arms. Hunching the shoulders compromises the architecture of this area, affecting blood supply to and from the arms, and nerve functions in the arms." If you suffer from strange arm pain or frequently have cold hands, this can remedy the problem. The good news is that practicing stretchsitting, as with the other lessons in the book, requires little more than a folded towel and chair.

Another important lesson covered in this book is stacksitting. Once again, we learn about the significance of pelvic positioning, and why it is critical to tilt the pelvis slightly forward. People that slouch have a tendency to tuck the pelvis, and as a result, the surrounding structures become accustomed to this. As Gokhale says, "The muscles and ligaments in the groin area as well as the hamstring muscles, tend to be short and tight, while the muscles in the buttocks tend to be weak and underdeveloped." The author details the differences in the shape of the low back, from swayed (a lordotic curve in which the low back muscles are tight), to rounded (a kyphotic curve that causes the discs to bulge), and finally a straight (ideal) shape where the muscles are relaxed and the discs are decompressed. Stacksitting involves some of the same concepts that were discussed in stretchsitting, and requires a folded towel (to help antevert the pelvis), sitting back deeply in a chair, and working to sit tall so that the vertebrae stack on top of one another to alleviate disc compression. Gokhale shows how to take stock of your posture in the mirror before performing the lesson (with reference pictures to guide you), and also how to assess the spinal groove in your lower back. At the end of the lesson, she describes how you can gauge improvement and what you can do if you feel pain or soreness in the lower back while you perform the exercises.

Tallstanding is one more lesson that I found valuable. Standing in an anatomically correct and comfortable position involves not just the alignment of your spine and pelvis, but also the positioning of your knees and feet. People who are uncomfortable standing for reasonable lengths of time often have problems with their knees and feet as well as their lower back. When standing, the knees should remain soft rather than locked; this prevents wear and tear on the knee, hip, ankle, and foot joints. Gokhale also talks about restoring the natural "kidney bean" shape to the foot. Fallen foot arches result from weak tibialis anterior muscles (the muscles on the front of the shin), as well as muscles of the foot. There is a great section in this chapter about foot anatomy, and if you look at the bones of the foot you can see that most of the weight when we stand is designed to be born by the heel bone. The heel is the largest bone of the foot, and the bones toward the front of the foot are smaller and more delicate. The highlights of tallstanding involve shifting most of your weight onto your heels, keeping your knees soft (not locked, and not bent), maintaining an anteverted pelvis, and allowing your vertebrae to stack on top of one another. The use of a mirror in this particular lesson is very helpful.

I like the fact that each one of these lessons builds upon what is learned in the previous lesson. Gokhale says that if extreme pain or discomfort is experienced, then certain lessons can be skipped for the time being until the subject becomes a bit stronger or the pain subsides. Also encouraging is that the author makes repeated reference to the importance of neutral head position. As most of you know, this is something that is emphasized during Total Results workouts, and is absolutely critical for the safety of the neck structures. If there is a point of contention I have, it is with many of the exercises detailed in the appendix section of the book. Several of the exercises involve unilateral movement which unevenly load the pelvis and spine; these I would avoid. Some of these exercises might provide minimal benefit to a person that is extremely deconditioned, but they are neither desirable nor necessary if you strength train regularly.

The lessons and strategies discussed in "8 Steps to a Pain-Free Back" are a useful adjunct to regular Total Results workouts, especially if you suffer from regular or even intermittent lower back pain. Just the extra awareness gained in terms of how you stand, sit, lie, and walk is worthwhile. I recommend this book to all Total Results clients and anyone else that wants to attain or maintain healthy posture.

Posted July 22, 2021 by Matthew Romans

The Linear Spine Flexion Machine

In my opinion, the Linear Spine Flexion Machine found here at Total Results is one of the most innovative exercise machines ever designed. You cannot find anything in a commercial gym that is even a reasonable facsimile. While the original Nautilus Pullover (early 1970's) was revolutionary and ushered in a new era in the field of exercise, the Linear Spine Flexion is unlike anything we have seen before or since its invention. Both the Linear Spine Flexion and its companion piece the Linear Spine Extension (which we do not own at Total Results) were designed by Ken Hutchins to target the trunk musculature in a way that had never before been possible.

The Linear Spine Flexion primarily targets the abdominal muscles, but also significantly engages the hamstrings and buttocks. Since most traditional abdominal exercises (whether using a machine or doing floor crunches) are rotational movements, they greatly involve the hip flexor muscles at the expense of the abdominals. The Linear Spine Flexion, as the name suggests, is a linear movement rather than a rotational movement, so hip flexor involvement is minimal and more direct attention can be given to the abdominal muscles. The subject will enter the machine facing the weight stack, and the seat height should be set so that the movement arm plunger is in contact with the back equidistant between the shoulder and hip joints. Once seated, the knees are usually placed between the second and third roller pads (or in a position so that the thighs are roughly parallel to the floor), with the shins in contact with the remaining pads, and the feet and ankles should be relaxed. A timing crank customizes the cam fall-off; the crank should be adjusted by the instructor so that the trunk is extended and the arms are mostly (if not completely) straight at bottom out. The heels of the hands should be in contact with the rung appropriate for one's arm length. A neutral head position should be maintained throughout the exercise.

The exercise will commence when the subject applies enough force to barely create movement of the plunger. In addition to pressing the back into the plunger, pressure should be applied on the rungs through the heels of the hands, and both shins should be pressed into the diagonal row of roller pads. The subject should strive to sink their butt down into the seat as they flex their trunk. To illustrate this trunk flexion, I often tell the client to "pretend they're trying to fold themselves in half, like a piece of paper." Once the greatest amount of flexion has been achieved, smoothly change directions to begin the negative phase of the movement. The chest should rise and the trunk should extend as you approach bottom out. Softly touch the plates together and begin the next repetition. There is a range of motion indicator attached to the shaft of the plunger. Once the client is no longer able to achieve their greatest range of motion, we have determined that they have reached momentary muscular failure, and they will push for an additional five to ten seconds to achieve a thorough inroad. The instructor will release the timing crank so that the subject can step safely off the machine deck and onto the floor.

This is a very demanding and technically challenging exercise, and it can take several sessions to perform it proficiently. It can be incorporated in the beginning of a workout, as in a pre-exhaust for the buttocks prior to the Leg Press, or it can be done at the end of a workout as a finishing movement. Most of my twice per week clients perform two different workout routines each week (an "A" and a "B" routine); I like to have the Linear Spine Flexion in the workout that does not contain the Leg Press and Leg Curl, because of how heavily involved the hamstrings and buttocks are in this exercise. As a bonus, according to Ken Hutchins this exercise "is also known for relieving even the most debilitating menstrual cramps within 3-5 repetitions."

Simply put, the Linear Spine Flexion is a machine unlike any other that you'll find in Northern Virginia, and we are very fortunate to offer its benefits to our clients. Schedule an appointment and experience it for yourself today!

Posted July 20, 2021 by Matthew Romans

A Blueprint For Success

In order to succeed in any endeavor, you need to have a system in place that you can utilize for the long term. This is true in business, the pursuit of an education, and even in raising children. It's great to know what you want to achieve, but if you don't have a plan in place to get you to where you want to go, all the good intentions in the world will not help you. This scenario happens to many people who join gyms or start fitness regimens in January. They start out with all kinds of enthusiasm and positive energy, and many of them have an idea (realistic or not) of what they want to accomplish. The trouble is, they have no idea how to get there and no system in place; consequently, they often flounder and stop what they're doing by mid February.

At Total Results, we explain to our clients that their success is mostly dependent upon them, which means they are firmly in control of their own destiny. The first important step taken toward achieving something meaningful is having the desire to do so, but that isn't enough. We give you the tools (in terms of knowledge) and the guidance necessary to maximize your genetic potential. The Total Results exercise philosophy originated as an outgrowth of the old Nautilus philosophy of the 1970s, and has been refined and improved through trial and error and continuous study since we first opened our doors twenty years ago. Our blueprint for success is made up of four critical elements: exercise instruction, nutritional education, regulation of additional activities, and supplement recommendations.

Exercise instruction. Our exercise protocol is based on the classical sciences of biology, chemistry, and physics, as well as motor learning. We utilize a slow and controlled speed of movement (ten seconds lifting and lowering the weight) with an emphasis on precise change of direction. Exercises are selected that will provide the greatest benefit in the shortest amount of time, with careful consideration given to any joint problems the client may be dealing with. Workouts are performed using specially engineered equipment made exclusively for our exercise protocol, and that combined with our clinically controlled environment enable the client to give their workout the proper amount of focus and intensity necessary to stimulate positive physical change. Total Results instructors are required to pass an extremely rigorous written, practical, and oral exam in order to certify, and must continue to learn and hone their craft going forward.

Nutritional guidance. We encourage clients to adopt a whole foods/evolutionary approach to nutrition in order to maximize their genetic blueprint and avoid chronic disease. The word accountability is stressed, and we talk about the importance of proper hydration, consuming plenty of healthy fats, protein, and fruits and vegetables, and avoiding the pitfalls of the traditional modern Western diet. Intermittent fasting (when you condense your time between first and last meals of the day) and all of its physiological benefits are regularly discussed.

Supplement education. If you are on one or more prescription medications for chronic conditions, our goal is to help you get off as many of them (or all of them) as soon as possible! Stay out of the health care (more appropriately, sick care) system by taking control of what you put into your body. Consume supplements such as Vitamins C and D, zinc, magnesium, fish oil, and (if you suffer from joint pain/arthritis) glucosamine and chondroitin. These supplements provide amazing benefits and have little or no side effects, unlike prescription medications.

Regulation of additional activities. We encourage clients to be active between sessions, but also to exercise sound judgement regarding intensity, frequency, and duration of extracurricular activities. The human body was designed to move, not sit still in one place all day long. That being said, no other form of activity is going to have the same systemic effect as a Total Results workout, and the human body has finite recovery resources. We want our clients to be active and get the most out of life, but also to experience continued progress and avoid unnecessary injuries.

The Total Results blueprint for success has been developed and refined after performing tens of thousands of one on one exercise sessions over the course of twenty years, and we continue to improve our knowledge so that we can get better and continue to provide you with the best exercise experience in the mid-Atlantic region. You can develop your own blueprint or system at home when it comes to managing stress and getting proper sleep, and this is something that we can help you with as well. Total Results instructors and clients form a combination that is both powerful and meaningful. If you would like to get started on your own blueprint for success, please contact us today.

Posted July 03, 2021 by Matthew Romans