Showing posts with label well-being. Show all posts
Showing posts with label well-being. Show all posts
Thursday, April 29, 2010
Kettlebell Swings: harder than Circuit Weight Traning; easier than Treadmill? How can this be?
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There's a new study in English of Kettlebells that shows 12mins of two handed swings is tougher/harder than circuit weight training, but not as hard as treadmill work. That's probably a surprise for folks used to swinging kettlebells, and certainly how kettelbells have been promoted as an amazing, tough, cardio conditioning endurance tool, where more is more. What this great new study does, therefore, is help us ask some questions about studying kb's. It also gives us new ways to think about where kb work might be situated relative to other activities. So this post is a wee overview of one of the first english language, peer reviewed articles on Kettlebells.
There's not a lot of english-based research on the effects of using kettlebells. In the latest Journal of strength and Conditioning, though, there is a small paper looking specifically at a 12 min 2 handed swing protocol. The authors credit this protocol as "Dept of Energy Man Maker" described in Pavel Tsatsouline's Enter the kettlebell. Just a note, however: the protocol from what is in Enter the Kettlebell is a wee bit different than what these sudy authors use - it's looser. Here's Tsatsouline's description:
Indeed, the protocol is even less specific in Bill Cullen's founding eponymous article describing it.
the routine’s published description, for 12 minutes in duration." Er, and that would mean? Sets of high reps with jogging? No, because later it reads:
Standard benchmark tests for max heart rate and vo2 were taken; then during the actual kb trial, VO2 and HR levels were recorded throughout the 12 min swing set. The study looked at just this one kb experience. Results varied pretty wildly among participants (10 "active" men).
Even given that "active men" were doing this, the results seem to have a heck of a standard deviation in such a small sample size, eh? I'm curious about how many times people stopped. Did the person with the lowest score only stop once? Did the best score recover frequently? That would be interesting to know.
Main results: during the kb effort, %HRmax was "significantly higher (p<0.001) than average VO2max. That's a bit of a surprise. One would usually expect that %HRmax would be strongly corelated to predicted VO2max. For instance, 85% MaxHR should connect with about 75% VO2max (see calculation here). In this small study of "active men" however,
What the results of the study mean
These results show that, at least according to the ACSM, the KB 12 min swing circuit rates as "hard". Second, the respiratory exchange ratio (RER) shows that the 12min effort means that this workout is high in "non-oxidative metabolism." That means that these 12 mins are not primarily fat burning minutes - calorie burning yes, but where many of those calories are coming from sources other than fat. But these results do suggest, that at least in this protocol, this is not a hugely stimulating protocol for enhancing Vo2max.
So again, i'd say that the way this protocol must have been run was out for a stroll with the 16, it still shows a pretty durn good effect, cardio wise.
Where does this KB workout Fit?
In terms of other similarly tested workouts - circuit weight training (see description of cwt here, mid port) and treadmill running, amazingly, it's higher than circuit weight training but lower than treadmill running.
The authors recommend that this particular protocol is good for cardio training, but that coaches should be aware that the HR cost relative to the VO2 demainds. Treadmill work (where speed and incline are used to push on cardio work).
Moving Ahead
The intent of this study the authors say "was to document the heart rate (HR) response and oxygen cost of performing a kettlebell exercise routine that is intended to improve cardiorespiratory fitness." That's a rather general claim to make about investigating ONE protocol - one way - of working with a kb.
It's also a protocol used in ETK specifically, as "a smoker" as bill cullen called it and as a "man maker" as its name implies. That's pretty much an all out effort for miles not time and "until you leave a lung on the ground." That's not, it seems, how this study ran the protocol. That's ok; just don't call it a particular protocol if that's not the test you're running.
On the high side, it's great to see the formal research running assessments of KB protocols in a comparative, peer reviewed study. A recent American Council of Exercise test shows that kb's are just awesome for Vo2max training in particular - they effectively paid to have Kenneth Jay's protocol for VO2max replicated and tested, but without standard research protocols for running a comparative analysis, or having the protocol peer reviewed. Indeed, it's at the very least intriguing that the results in that article (shown in the image below) using the snatch got such different results than the swing - that's in 20mins, with 15 secs on, snatching, 15 secs off, as opposed to 12mins, swinging as many reps as possible non-stop.
Not saying there's anything wrong with these results - just that the benefit of the JSCR shorty gives us a way to situate a KB protocol relative to OTHER kinds of training, and the results are a wee bit of a surprise - we tend to think that all kb's all the time are the hardest ass whopping we can get. And, what seems to have been the case here, is that sure, if you're not swinging with intent to get smoked, you don't get smoking results.
But that's ok. Not all protocols, all the time. And that's actually a good thing. We need physiological variety. Now we're learning what kind of variety kb's can deliver - relative to other workouts.
Looking forward to more formal KB research, to learn more about this awesome fitness tool.
Related Resources
There's a new study in English of Kettlebells that shows 12mins of two handed swings is tougher/harder than circuit weight training, but not as hard as treadmill work. That's probably a surprise for folks used to swinging kettlebells, and certainly how kettelbells have been promoted as an amazing, tough, cardio conditioning endurance tool, where more is more. What this great new study does, therefore, is help us ask some questions about studying kb's. It also gives us new ways to think about where kb work might be situated relative to other activities. So this post is a wee overview of one of the first english language, peer reviewed articles on Kettlebells.There's not a lot of english-based research on the effects of using kettlebells. In the latest Journal of strength and Conditioning, though, there is a small paper looking specifically at a 12 min 2 handed swing protocol. The authors credit this protocol as "Dept of Energy Man Maker" described in Pavel Tsatsouline's Enter the kettlebell. Just a note, however: the protocol from what is in Enter the Kettlebell is a wee bit different than what these sudy authors use - it's looser. Here's Tsatsouline's description:
The Man Maker is a painfully simple workout that was devised and implemented at a federal agency’s academy by Green Beret vet Bill Cullen, RKC. Its template is simple: alternate sets of high-rep kettlebell drills—swings in our case—with a few hundred yards of jogging. Do your swings “to a comfortable stop” most of the time and all-out occasionally. Don’t run hard; jogging is a form of active recovery. Senior RKC Mike Mahler prefers the jump rope to jogging, another great option.
Indeed, the protocol is even less specific in Bill Cullen's founding eponymous article describing it.
Do 10 to 75 snatches with each arm depending on your ability level, be sure that you use good form, dig your toes in, and at the top of your snatch or swing hold for a second. Breathing is important, get a good rhythm going. Once done with your snatches jog -don’t run! - quarter of a mile, jogging lets your heart and body recover, if you are running fast it means you didn’t do enough repetitions with your KB.Note that the quantifier in Cullen's work is distance rather than time and number of snatches rather than time. The protocol tested in the study is, by contrast, more specific. It's 12 mins of 2 handed swings. Not sure where 12 mins came from, but the version run in the study is described in three different ways. First, the abstract describes it as "a kettlebell exercise routine consisting of as many 2-handed swings as could be completed in 12 minutes using a 16-kg kettlebell." I initially thought this meant "continuous" swings. But, in the article itself - thanks to Mike Reid, RKC for pointing this out, it is described as "Subjects performed 2-handed swings, in accordance with
Continue this routine for 2 miles or farther or till you leave a lung on the ground. This is a fat buster and a cardio gut check but the great thing is you can always make it harder or easier by tweaking the number of repetitions.
the routine’s published description, for 12 minutes in duration." Er, and that would mean? Sets of high reps with jogging? No, because later it reads:
Subjects completed a 12-minute exercise bout, known as the ‘‘US Department of Energy Man-Maker’’ (ETK). The bout consisted of performing 2-handed swings, using a 16-kg kettlebell (Perform Better, Cranston, RI) for 12-minute duration. A 16-kg kettlebell was used in this study because that is a recommended weight for beginning men (ETK). Subjects were told to work at their own pace, resting as needed, while aiming to complete as many swings as possible in the 12-minute time frame. Heart rate was monitored continuously and recorded every minute of the bout.Ok, so what is not the man maker is that (a) time is fixed at 12 mins (b) there is no active recovery, one is "working at their own pace" rather than, in Cullen's case of this routine being a "smoker" as hard as possible. I'd nay be inclined to call this the man maker, then. More "swing at your own pace, stopping as often as necessary, to get as many swings in as possible for 12 mins"
Standard benchmark tests for max heart rate and vo2 were taken; then during the actual kb trial, VO2 and HR levels were recorded throughout the 12 min swing set. The study looked at just this one kb experience. Results varied pretty wildly among participants (10 "active" men).
Subjects completed an average of 265 plus or minus 68 swings during the 12 minutes, for an average work rate of 22 plus or minus 6 swings per minute.Ok, looking at the numbers, 12 mins of swings, does this sound like a man maker to anyone who's focused on a "smoker"? Just looking at myself, a wee 5'6", 60kg female, i do 100 swings for recovery during RTK with a 12 or 16 - i just checked with the 16 - it's 2 mins and a bit. So i'm mystified at how non-manmaker'ish (ie "smoker") this protocol must have been run.
Even given that "active men" were doing this, the results seem to have a heck of a standard deviation in such a small sample size, eh? I'm curious about how many times people stopped. Did the person with the lowest score only stop once? Did the best score recover frequently? That would be interesting to know.
Main results: during the kb effort, %HRmax was "significantly higher (p<0.001) than average VO2max. That's a bit of a surprise. One would usually expect that %HRmax would be strongly corelated to predicted VO2max. For instance, 85% MaxHR should connect with about 75% VO2max (see calculation here). In this small study of "active men" however,
The equation describing the regression line to predict %V̇o2max from %HRmax was %V̇o2max = 0.714%HRmax − 4.57, with a significant correlation of 0.58 and an SEE of 6.6%. Figure 2 illustrates the relationship between %V̇o2max and %HRmax.That resulted in an 85% max heart with 65% V02max
What the results of the study mean
These results show that, at least according to the ACSM, the KB 12 min swing circuit rates as "hard". Second, the respiratory exchange ratio (RER) shows that the 12min effort means that this workout is high in "non-oxidative metabolism." That means that these 12 mins are not primarily fat burning minutes - calorie burning yes, but where many of those calories are coming from sources other than fat. But these results do suggest, that at least in this protocol, this is not a hugely stimulating protocol for enhancing Vo2max.
So again, i'd say that the way this protocol must have been run was out for a stroll with the 16, it still shows a pretty durn good effect, cardio wise.
Where does this KB workout Fit?
In terms of other similarly tested workouts - circuit weight training (see description of cwt here, mid port) and treadmill running, amazingly, it's higher than circuit weight training but lower than treadmill running.
lance armstrong: two handed kb swing
The authors recommend that this particular protocol is good for cardio training, but that coaches should be aware that the HR cost relative to the VO2 demainds. Treadmill work (where speed and incline are used to push on cardio work).
Moving Ahead
The intent of this study the authors say "was to document the heart rate (HR) response and oxygen cost of performing a kettlebell exercise routine that is intended to improve cardiorespiratory fitness." That's a rather general claim to make about investigating ONE protocol - one way - of working with a kb.
It's also a protocol used in ETK specifically, as "a smoker" as bill cullen called it and as a "man maker" as its name implies. That's pretty much an all out effort for miles not time and "until you leave a lung on the ground." That's not, it seems, how this study ran the protocol. That's ok; just don't call it a particular protocol if that's not the test you're running.
On the high side, it's great to see the formal research running assessments of KB protocols in a comparative, peer reviewed study. A recent American Council of Exercise test shows that kb's are just awesome for Vo2max training in particular - they effectively paid to have Kenneth Jay's protocol for VO2max replicated and tested, but without standard research protocols for running a comparative analysis, or having the protocol peer reviewed. Indeed, it's at the very least intriguing that the results in that article (shown in the image below) using the snatch got such different results than the swing - that's in 20mins, with 15 secs on, snatching, 15 secs off, as opposed to 12mins, swinging as many reps as possible non-stop.
Not saying there's anything wrong with these results - just that the benefit of the JSCR shorty gives us a way to situate a KB protocol relative to OTHER kinds of training, and the results are a wee bit of a surprise - we tend to think that all kb's all the time are the hardest ass whopping we can get. And, what seems to have been the case here, is that sure, if you're not swinging with intent to get smoked, you don't get smoking results.
But that's ok. Not all protocols, all the time. And that's actually a good thing. We need physiological variety. Now we're learning what kind of variety kb's can deliver - relative to other workouts.
Looking forward to more formal KB research, to learn more about this awesome fitness tool.
Related Resources
- b2d KB article index
- Review of KJ's Viking Warrior Conditioning (VO2max)
- Cardio, VO2max, Kettlebells
- Hill Workouts with Kettlebells
- Respect the Fat - the role of fat in energy metabolism
- 6 mins a week workouts?
Farrar RE, Mayhew JL, & Koch AJ (2010). Oxygen cost of kettlebell swings. Journal of strength and conditioning research / National Strength & Conditioning Association, 24 (4), 1034-6 PMID: 20300022Tweet Follow @begin2dig
PDF
Friday, April 23, 2010
90 Seconds or less to Bond: skills of social engagement
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A bit ago i wrote about how Robert Sapolsky's Why Zebras Don't Get Ulcers
describes a rich variety
of animal case studies of coping with stress in these creatures natural habitats. A biggie of stress seen among our non-human kindred is the effect on longevity and quality of life. A key factor in bringing down stress and increasing longevity? Good socialization. After looking at Sapolsky's work it became clear that the research i do on well-being which had been focusing on nutrition, movement and rest/recovery needed to add in socialisation. But how?
In nutrition, movement and recovery, i've been keenly aware that there are skills for each of these practices, and i've spent some time researching, practicing and writing about some of them. Socialization has been a bit of a mystery, though. What skills would one even look for? We're not talking about etiquette, but about how to connect and play nice with others. Thumbing through the material for the various management and leadership courses i'd been on didn't percolate up anything about basic human engagement. In coaching, the closest thing seemed to be motivational interviewing, but that's not developing peer-to-peer encounter skills.
And then, it - or at least a partial it - happened. I came across this fabulously concise (audio) book: how to make people like you in 90 seconds or less by Nicholas Boothman (uk cd | uk book|| us book
| us cd
).
In this wee book, Boothman presents a suite of skills to help us connect with people. These skills start before the first hello, such that the work of those 90 initial seconds (or less) in someone's company are richly prepared for optimal success.
The title sounds rather flakey, but in actual fact the skills are well founded in concepts like neural linguistic programming. That practice too sounds a little daunting as a controversial area of psychotherapy from the same era as TM. But whether one accepts the entire NLP package or not, the very pragmatic and specific application of it to human close encounters is both easy to grasp and to test with this simple question: do these techniques enable me to engage with other people more of the time and more successfully in more situations? For an introvert like myself, trying to add this Fourth Front of WellBeing to my skill set, believe me, this stuff has to be pretty robust if it's going to work. And it does seem to be helping.
Boothman sets up a handful of concepts, from introduction approaches, to paying attention to the kind of language another uses (visual, auditory, kinesthetic) in order to successfully and quickly get on to that other person's wavelength.
Some of the techniques in the book will likely sound like simple politeness: be aware of cues from one person's conversation of where they want to go rather than pushing our own agenda/interests first. Other skills are more subtle: learn what to watch in body language cues for openness and engagement and where the body language matches words spoken - or does not.
And that's really it seems what these skills are mainly about: how attend with intent to an other in order to enable that person to feel comfortable. This comfort is achieved by having so modulating oneself to be on that other person's wavelenght that they feel safe, at home, we're sufficiently the same to share this exchange.
I'm looking forward to finding other books that map out more skills in the socializing space, but it seems remarkably appropriate that the first source that seems to fall into my hands (or ipod) is about these first steps to Making Contact.
If you too might like to improve the quality of your contact with Others, then i'd recommend this wee tome or cd set. Tweet Follow @begin2dig
A bit ago i wrote about how Robert Sapolsky's Why Zebras Don't Get Ulcers describes a rich variety of animal case studies of coping with stress in these creatures natural habitats. A biggie of stress seen among our non-human kindred is the effect on longevity and quality of life. A key factor in bringing down stress and increasing longevity? Good socialization. After looking at Sapolsky's work it became clear that the research i do on well-being which had been focusing on nutrition, movement and rest/recovery needed to add in socialisation. But how?In nutrition, movement and recovery, i've been keenly aware that there are skills for each of these practices, and i've spent some time researching, practicing and writing about some of them. Socialization has been a bit of a mystery, though. What skills would one even look for? We're not talking about etiquette, but about how to connect and play nice with others. Thumbing through the material for the various management and leadership courses i'd been on didn't percolate up anything about basic human engagement. In coaching, the closest thing seemed to be motivational interviewing, but that's not developing peer-to-peer encounter skills.
And then, it - or at least a partial it - happened. I came across this fabulously concise (audio) book: how to make people like you in 90 seconds or less by Nicholas Boothman (uk cd | uk book|| us book | us cd).In this wee book, Boothman presents a suite of skills to help us connect with people. These skills start before the first hello, such that the work of those 90 initial seconds (or less) in someone's company are richly prepared for optimal success.
The title sounds rather flakey, but in actual fact the skills are well founded in concepts like neural linguistic programming. That practice too sounds a little daunting as a controversial area of psychotherapy from the same era as TM. But whether one accepts the entire NLP package or not, the very pragmatic and specific application of it to human close encounters is both easy to grasp and to test with this simple question: do these techniques enable me to engage with other people more of the time and more successfully in more situations? For an introvert like myself, trying to add this Fourth Front of WellBeing to my skill set, believe me, this stuff has to be pretty robust if it's going to work. And it does seem to be helping.
Boothman sets up a handful of concepts, from introduction approaches, to paying attention to the kind of language another uses (visual, auditory, kinesthetic) in order to successfully and quickly get on to that other person's wavelength.
Some of the techniques in the book will likely sound like simple politeness: be aware of cues from one person's conversation of where they want to go rather than pushing our own agenda/interests first. Other skills are more subtle: learn what to watch in body language cues for openness and engagement and where the body language matches words spoken - or does not.
And that's really it seems what these skills are mainly about: how attend with intent to an other in order to enable that person to feel comfortable. This comfort is achieved by having so modulating oneself to be on that other person's wavelenght that they feel safe, at home, we're sufficiently the same to share this exchange.
I'm looking forward to finding other books that map out more skills in the socializing space, but it seems remarkably appropriate that the first source that seems to fall into my hands (or ipod) is about these first steps to Making Contact.
If you too might like to improve the quality of your contact with Others, then i'd recommend this wee tome or cd set. Tweet Follow @begin2dig
Thursday, April 22, 2010
Eccentric Exercise - some cool ideas as to why it seems to heal certain tendinopathies (ps, ditch -itis and -osis)
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Have you been suffering with some kind of sore tendon/jointy pain? Rotator cuff area, achiles, elbow, forearm, rsi etc etc? Guess what? First we're not alone, but second, just about anything that's been tried to address it has no real evidence to support it working, especially over time. Indeed, as the authors of a 2009 review study put it, "Tendinopathy is common although pathology of this condition is poorly understood." In other words, we don't really know how this dis-ease works. The point of this article is to consider why, as these authors see it, Eccentric Exercise (EE) which has seemed to have some good, some neutral results in research, may actually be successfully addressing the effects of that pathology. So much so, that it gets rated as a good "conservative" therapy for these kinds of common, awful and sometimes career ending, painful problems.
By way of context, in 2008, the year before these authors proposed why EE might be useful, another group reviewed pretty much everything under the sun applied to tendinopathies, from NSAIDS to shock wave therapy (and anything else one's GP may recommend). THe paper has the remarkably useful title "Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon"
They write of these therapies:
It's almost as bad as the common cold: ubiquitous and no idea how to cure it.
By 2009, however, the UK group of scientists seems ready to say that EE is a good "conservative" treatment for tendinopathy. What's quite remarkable is why they're making this claim, and that's at the heart of this article.
Tendinopathy?
But first things first, just to be sure we're all on the same page, what is tendinopathy? Tendinopathy is the umbrella term that includes, among other considerations, tendinosis and tendinitis. As for the differences between these two, on a functional level, Mike Nelson puts it nicely:
Hence we circle back to the term tendinopathy to cover this not unusually mixed condition of perhaps some inflammation but in particular, "degeneration, weakness, tearing, and pain" Hence both osis (tears) and itis (inflammation) may neither be particularly pathologically accurate or diagnostically helpful. And so, tendinopathy is the new and more robust term for these conditions.
With that note in mind, let me also add that the following discussion is not meant to be a prescription of any course of action. Get yourself checked with your doctor before starting anything. In my own case i have been disappointed by the fact that the thing that has actually helped the most immediately has been taking NSAIDS - some inflammation, or -itis maybe?
After a month of other non-drug interventions, day one after finally breaking down and seeing the doc: bam - immediate reduction in the pain that was making putting on a jacket a painful experience. bugger. But ah ha, it ain't all better that's for sure. What to do next? My hope is that the following research may offer some insight into WHAT to do if not exactly how and when to do it.
Eccentric Exercise and Tendinopathy
The authors of "Eccentric exercises; why do they work, what are the problems and how can we improve them?" J D Rees, R L Wolman, A Wilson write in the abstract:
The body of the article focuses on Achilles tendinopathy (mid back of the leg - base of the calf muscles), Insertional Achilles tendinopathy (where the tendon inserts away from the calf muscles, down by the ankle where it attaches to the bone) , Patellar tendon (either side of the knee cap) in particular.
The authors' insight has been to look at where in the tendon the lesion is occuring. Is it where the tendon attaches to the bone or where it attaches to the muscle? The effects of EE in the small number of studies are all over the map, so it's hard to draw any conclusion except, it seems, that where the lesion is on the tendon seems to have a correlation between the degree to which EE will be successful. For insertional achilles, as opposed to "the main body" of the tendon, EE's not showing up as so great. With the paterllar tendons, while some studies have shown benefit, especially over CE or concentric, whether there's a difference around proximal or insertional hasn't been the focus of research in such a way as it's possible to make a distinction.
With respect to other tendinopathies - like forearms (RSI kinda stuff) and elbows, the authors write:
What are Eccentrics Doing?
Despite this rather promising but still arid, partial research landscape for EE and tendinopathy, the authors have some ideas about the mechanisms that may be at play in eccentric efforts
Another factor the authors consider is blood flow. When we see tendons illustrated in anatomy texts, they're usually white-ish. That's the lack of a whole lot of blood going through them. This limit is in no small part why tendons can take longer than just about anything else to heal. So improving blood flow to tendons - blood being a nutrient carrier - could seemingly be a big plus. The authors write
Where using the Force Mayn't Matter. All this is cool, but it doesn't explain WHY these effects are occuring from EE. In particular, something the scientists can conclude rather strongly from the work that's been carried out is that the magnitude of the force has nothing to do with it. So lifting a big weight, or lifting a lighter weight faster (F=M*A) isn't what's getting the job done.
The key question the authors ask is:
Frequency rather than Force. This is so cool - it sounds great too: that the sort of cycling on and off of the muscle (the sinusoidal loading and unloading) during the eccentric may be the biggie in stimulating that good collagen rebuilding in particular associated with EE and maybe the blood flow too. The other interesting part is that there is a possible parallel to bone remodelling here (and Woolf's law).
That is, as force is applied to a bone it will get bigger (the outer shell gets pushed out it seems, as the inner lace work architecture increases) and so stronger to respond to that demand. Davis's law on tissue seems a wee bit similar: "If soft tissue is placed under unremitting tension, the tissue will elongate by adding more material. "
Bottom line: the particular type of muscular demands to maintain control of a load in extension (force fluctuations not force magnitude) may play a particular role in remodeling tendons in these various opathies.
Whither, Voyager for Futuer EE / Tendinopathy Research?
The authors are now happy to say EE seems to have sufficient basis to be considered viable. Time to figure out how to optimize it. THey write in the Future Work section:
As an example of eccentric exercises that have been tried out among at least a small population of elbow-opathies, Mike T Nelson's developed some nice eccentrics work with a kettlebell. Well worth a look and a go.
What i've been working lately for my shoulder/painful arc thing:
Concludium
Perhaps the main take away from this summary of recent research reviews and primary work is that tendinitis vs osis is largely a non-starter; tendinopathy is where it's at. And saying that, the pathology or dis-ease of tendinopathy is not well understood, which may also explain why treatements - in particular long term ones - don't have much evidence to support their efficacy. There are some prospective treatements on the horizon, however, with eccentric exercise amongthem. This latest study on EE and tendinopathy seems to propose the best hypothesis so far as to why eccentric exercises is showing up as particularly effective for at least main body tendinopathy.
Citations:
Related Resources
Have you been suffering with some kind of sore tendon/jointy pain? Rotator cuff area, achiles, elbow, forearm, rsi etc etc? Guess what? First we're not alone, but second, just about anything that's been tried to address it has no real evidence to support it working, especially over time. Indeed, as the authors of a 2009 review study put it, "Tendinopathy is common although pathology of this condition is poorly understood." In other words, we don't really know how this dis-ease works. The point of this article is to consider why, as these authors see it, Eccentric Exercise (EE) which has seemed to have some good, some neutral results in research, may actually be successfully addressing the effects of that pathology. So much so, that it gets rated as a good "conservative" therapy for these kinds of common, awful and sometimes career ending, painful problems. By way of context, in 2008, the year before these authors proposed why EE might be useful, another group reviewed pretty much everything under the sun applied to tendinopathies, from NSAIDS to shock wave therapy (and anything else one's GP may recommend). THe paper has the remarkably useful title "Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon"
They write of these therapies:
Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Recent basic science research suggests little or no inflammation is present in these conditions. Thus, traditional treatment modalities aimed at controlling inflammation such as corticosteroid injections and nonsteroidal antiinflammatory medications (NSAIDS) may not be the most effective options. We performed a systematic review of the literature to determine the best treatment options for tendinopathy. We evaluated the effectiveness of NSAIDS, corticosteroid injections, exercise-based physical therapy, physical therapy modalities, shock wave therapy, sclerotherapy, nitric oxide patches, surgery, growth factors, and stem cell treatment. NSAIDS and corticosteroids appear to provide pain relief in the short term, but their effectiveness in the long term has not been demonstrated. We identified inconsistent results with shock wave therapy and physical therapy modalities such as ultrasound, iontophoresis and low-level laser therapy. Current data support the use of eccentric strengthening protocols, sclerotherapy, and nitric oxide patches, but larger, multicenter trials are needed to confirm the early results with these treatments. Preliminary work with growth factors and stem cells is promising, but further study is required in these fields. Surgery remains the last option due to the morbidity and inconsistent outcomes. The ideal treatment for tendinopathy remains unclear.
It's almost as bad as the common cold: ubiquitous and no idea how to cure it.
It's interesting that from that mix of "current data" strategies that look promising in the 2008 survey quoted above, the authors of the 2009 BJMS article are interested in eccentric exercises. In 2007, another group of researchers concluded a literature survey about Eccentric Exercise and chronic tendinopathy with the sad claim thatAside: And if you have a type of rotator cuff tendinopathy, and your doctor is suggesting a steroid shot? I'm motivated here as this is me. You may want to point that caregiver to this 2007 review of the lack of proven efficacy of this approach.
This systematic review of the available literature indicates that there is little reproducible evidence to support the efficacy of subacromial corticosteroid injection in managing rotator cuff disease.
the dearth of high‐quality research in support of the clinical effectiveness of EE over other treatments in the management of tendinopathies.In other words, good quality studies that would be taken as being say clinically significant are thin on the ground. They're not as rigerous as these scientists would like to see in the presciption of a protocol to treat something.
By 2009, however, the UK group of scientists seems ready to say that EE is a good "conservative" treatment for tendinopathy. What's quite remarkable is why they're making this claim, and that's at the heart of this article.
Tendinopathy?
But first things first, just to be sure we're all on the same page, what is tendinopathy? Tendinopathy is the umbrella term that includes, among other considerations, tendinosis and tendinitis. As for the differences between these two, on a functional level, Mike Nelson puts it nicely:
TendonITIS is normally from inflammation (itis). TendonOSIS is normally from messed up connective tissue.To get into a bit more detail, the intro to the 2008 survey is very helpful
Traditionally, pain in and around tendons associated with activity has been termed tendonitis. This terminology implies the pain associated with these conditions results from an inflammatory process. Not surprisingly, treatment modalities have mainly been aimed at controlling this inflammation. The mainstays of treatment have included rest, nonsteroidal antiinflammatory medications (NSAIDs), and periodic local corticosteroid injections.So for practitioners in the know, it seems the once-frequent diagnosis of "tendinitis" has gone down quite a bit - because inflammation may or may not be present, and when it is, may or may not be the main cause of pain. Also, there is an "imbalance" of protective/regenerative responses to overuse and pathological (diseease) responses. This is Mike's "messed up connective tissue."
There are two problems with this approach. First, several studies demonstrate little or no inflammation is actually present in tendons exposed to overuse [83, 96, 163]. Second, traditional treatment modalities aimed at modulating inflammation have had limited success in treating chronic, painful conditions arising from overuse of tendons. More recently, the term tendinopathy has been advocated to describe the variety of painful conditions that develop in and around tendons in response to overuse. Histopathologic changes associated with tendinopathy include degeneration and disorganization of collagen fibers, increased cellularity, and minimal inflammation [83, 163]. Macroscopic changes include tendon thickening, loss of mechanical properties, and pain [163]. Recent work demonstrates several changes occur in response to overuse including the production of matrix metalloproteinases (MMPs), tendon cell apoptosis, chondroid metaplasia of the tendon, and expression of protective factors such as insulin-like growth factor 1 (IGF-1) and nitric oxide synthetase (NOS) [10, 76, 93, 99, 154, 155, 174, 199]. Although many of these biochemical changes are pathologic and result in tendon degeneration, others appear beneficial or protective. Tendinopathy appears to result from an imbalance between the protective/regenerative changes and the pathologic responses that result from tendon overuse. The net result is tendon degeneration, weakness, tearing, and pain.
Hence we circle back to the term tendinopathy to cover this not unusually mixed condition of perhaps some inflammation but in particular, "degeneration, weakness, tearing, and pain" Hence both osis (tears) and itis (inflammation) may neither be particularly pathologically accurate or diagnostically helpful. And so, tendinopathy is the new and more robust term for these conditions.
With that note in mind, let me also add that the following discussion is not meant to be a prescription of any course of action. Get yourself checked with your doctor before starting anything. In my own case i have been disappointed by the fact that the thing that has actually helped the most immediately has been taking NSAIDS - some inflammation, or -itis maybe?
After a month of other non-drug interventions, day one after finally breaking down and seeing the doc: bam - immediate reduction in the pain that was making putting on a jacket a painful experience. bugger. But ah ha, it ain't all better that's for sure. What to do next? My hope is that the following research may offer some insight into WHAT to do if not exactly how and when to do it.
Eccentric Exercise and Tendinopathy
The authors of "Eccentric exercises; why do they work, what are the problems and how can we improve them?" J D Rees, R L Wolman, A Wilson write in the abstract:
Eccentric exercises (EE) have proved successful in the management of chronic tendinopathy, particularly of the Achilles and patellar tendons, where they have been shown to be effective in controlled trials. However, numerous questions regarding EE remain. The standard protocols are time-consuming and require very motivated patients. EE are effective in some tendinopathies but not others. Furthermore, the location of the lesion can have a profound effect on efficacy; for example, standard EE in insertional lesions of the Achilles are ineffective.So, the researchers are sitting with the 2007 surveyview that while there's some hints of promising evidence in the past about EE, it hasn't been super. They think that now, however, they have a better sense of what might be making it effective.
Until recently little was known of the effect of EE on tendinopathic tendons, although a greater understanding of this process is emerging. Additionally, recent in vivo evidence directly comparing eccentric and concentric exercises provides a possible explanation for the therapeutic benefit of EE. The challenge now is to make EE more effective. Suggestions on areas of future research are made.
The body of the article focuses on Achilles tendinopathy (mid back of the leg - base of the calf muscles), Insertional Achilles tendinopathy (where the tendon inserts away from the calf muscles, down by the ankle where it attaches to the bone) , Patellar tendon (either side of the knee cap) in particular. The authors' insight has been to look at where in the tendon the lesion is occuring. Is it where the tendon attaches to the bone or where it attaches to the muscle? The effects of EE in the small number of studies are all over the map, so it's hard to draw any conclusion except, it seems, that where the lesion is on the tendon seems to have a correlation between the degree to which EE will be successful. For insertional achilles, as opposed to "the main body" of the tendon, EE's not showing up as so great. With the paterllar tendons, while some studies have shown benefit, especially over CE or concentric, whether there's a difference around proximal or insertional hasn't been the focus of research in such a way as it's possible to make a distinction.
With respect to other tendinopathies - like forearms (RSI kinda stuff) and elbows, the authors write:
A small number of studies have examined the use of eccentric exercises in the management of tendinopathy of the lateral extensors of the forearms.26–28 There is some evidence suggestive of an increase in function using EE compared with ultrasound in the treatment of lateral extensor tendons,29 and a recent study adopted an isokinetic eccentric protocol in the management of lateral elbow tendinosis and reported promising results.30 No randomised study on the effectiveness of EE on the rotator cuff has been published, although a small uncontrolled pilot study of nine patients did suggest a significant benefit of EE (patients with arthritis of the acromioclavicular joint or significant calcification were, however, excluded).31 Further trials on both tendinopathy of the rotator cuff and lateral extensor forearm tendons are required in order to evaluate EE more fully.Just my luck: shoulders with EE haven't been evaluated. Time to become an experiment of one.
What are Eccentrics Doing?
Despite this rather promising but still arid, partial research landscape for EE and tendinopathy, the authors have some ideas about the mechanisms that may be at play in eccentric efforts
The pathophysiology of tendon injury and healing is incompletely understood. It does appear, however, that in established tendinosis the tendon often does not progress into an active (or at least successful) healing cycle. EE may work by providing a mechanical stimulus to the quiescent tendon cellsThe authors propose several interesting ways in which this "mechanical stimulus" may work. The first is on that all important building block for tissue, collagen
Physical training in general has been shown to increase both the synthesis and degradation of collagen,39 and in the longer term this may lead to a net increase in collagen. Recently it has been recently elegantly demonstrated by Langberg and coworkers, by use of the microdialysis technique, that a chronically injured Achilles tendon responds to a 12 week EE programme by increasing the rate of collagen synthesis.40 In this study 12 patients (six with Achilles tendinosis and six normal controls) performed EE over a 12 week period. The EE group had increased collagen synthesis (peritendinous type I collagen) without a corresponding increase in collagen degradation. There was also a corresponding drop in pain levels (in line with other studies).That collagen production - to repair tendon degredation - is a huge and good deal. Especially that the exercise is not causing breakdown, but actual rebuilding.
Another factor the authors consider is blood flow. When we see tendons illustrated in anatomy texts, they're usually white-ish. That's the lack of a whole lot of blood going through them. This limit is in no small part why tendons can take longer than just about anything else to heal. So improving blood flow to tendons - blood being a nutrient carrier - could seemingly be a big plus. The authors write
The effect of EE on Achilles tendon microcirculation has also been studied. Achilles tendon oxygenation was not impaired by an EE programme but was accompanied by a decrease in postcapillary venous filling pressures, the authors suggesting that this reflects improved blood flow. Again this study looked only at eccentric exercise so it is not possible to determine whether this is a specific effect of EE.In other words, concentric exercise may have the same benefit on blood flow as eccentric exercise - we don't know - but what we do seem to know is that exercise (in the studied case, eccentric) keeps the blood moving, circulating rather than sitting somewhere. The anti pump? in a good way?
Where using the Force Mayn't Matter. All this is cool, but it doesn't explain WHY these effects are occuring from EE. In particular, something the scientists can conclude rather strongly from the work that's been carried out is that the magnitude of the force has nothing to do with it. So lifting a big weight, or lifting a lighter weight faster (F=M*A) isn't what's getting the job done.
The key question the authors ask is:
If the efficacy of EE cannot be explained by the magnitude of force, then what is responsible?Great Question. They have one very intersting finding about eccentric exercise - the shape of control of the muscle when it's lengthening and contracting at the same time:
Intriguingly, we observed a pattern of sinusoidal loading and unloading in EE which was not demonstrated in CE. The fluctuations in force probably reflect the difficulty in controlling a dynamic movement with a lengthening muscle; similar to the experience that it is easier to lift a heavy weight under precise control than to lower the same weight. We propose that these fluctuations in force may provide an important stimulus for the remodelling of tendon. Certainly in the remodelling of bone it is known that bone responds to high-frequency loading and appropriate mechanical signals can lead to a dramatic increase in bone density.
Frequency rather than Force. This is so cool - it sounds great too: that the sort of cycling on and off of the muscle (the sinusoidal loading and unloading) during the eccentric may be the biggie in stimulating that good collagen rebuilding in particular associated with EE and maybe the blood flow too. The other interesting part is that there is a possible parallel to bone remodelling here (and Woolf's law).
That is, as force is applied to a bone it will get bigger (the outer shell gets pushed out it seems, as the inner lace work architecture increases) and so stronger to respond to that demand. Davis's law on tissue seems a wee bit similar: "If soft tissue is placed under unremitting tension, the tissue will elongate by adding more material. "
Bottom line: the particular type of muscular demands to maintain control of a load in extension (force fluctuations not force magnitude) may play a particular role in remodeling tendons in these various opathies.
Whither, Voyager for Futuer EE / Tendinopathy Research?
The authors are now happy to say EE seems to have sufficient basis to be considered viable. Time to figure out how to optimize it. THey write in the Future Work section:
Little is known of the optimal protocol for EE. Indeed, fundamental questions remain unanswered, such as how fast the exercises should be performed and progressed. This is certainly an area worthy of future research. The specific location of the pathology within a tendon has increasingly been shown to have an effect on the efficacy of EE, and further study in this area is also suggested. Other potential areas of research include studying the effect of periodisation of training, a technique currently perhaps more familiar to athletes and their coaches than to sports medicine physicians.Goodness, that's interesting. Periodization combined with frequency may be the sweet spot for rehab. Why not? It's excellent for anti-fatigue strength building; why not repair?
As an example of eccentric exercises that have been tried out among at least a small population of elbow-opathies, Mike T Nelson's developed some nice eccentrics work with a kettlebell. Well worth a look and a go.
What i've been working lately for my shoulder/painful arc thing:
put a wee kettelbell or light db in the hand of the sore side. bring hand up to chest (with weight in it), then lift elbow so it's parallel or close to shoulder height WITH NO PAIN - only go as high as you can with no pain
- slowly abduct the hand away from the chest, and potentially rotate wrist down (like pouring a jug) - if the load feels too heavy - brings on pain - bring hand in a bit; reduce turn in wrist; then lower the whole arm (not just the elbow but this L shape you're holding) so you're working the shoulder.
that lets one do the concentric pretty much unloaded and focus on a safe eccentric.
if you give that a go for a while let me know how that feels - just don't move into pain.
Concludium
Perhaps the main take away from this summary of recent research reviews and primary work is that tendinitis vs osis is largely a non-starter; tendinopathy is where it's at. And saying that, the pathology or dis-ease of tendinopathy is not well understood, which may also explain why treatements - in particular long term ones - don't have much evidence to support their efficacy. There are some prospective treatements on the horizon, however, with eccentric exercise amongthem. This latest study on EE and tendinopathy seems to propose the best hypothesis so far as to why eccentric exercises is showing up as particularly effective for at least main body tendinopathy.
Citations:
Rees, J., Wolman, R., & Wilson, A. (2009). Eccentric exercises; why do they work, what are the problems and how can we improve them? British Journal of Sports Medicine, 43 (4), 242-246 DOI: 10.1136/bjsm.2008.052910
Andres, B., & Murrell, G. (2008). Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon Clinical Orthopaedics and Related Research, 466 (7), 1539-1554 DOI: 10.1007/s11999-008-0260-1
Woodley, B., Newsham-West, R., Baxter, G., Kjaer, M., & Koehle, M. (2007). Chronic tendinopathy: effectiveness of eccentric exercise * COMMENTARY 1 * COMMENTARY 2 British Journal of Sports Medicine, 41 (4), 188-198 DOI: 10.1136/bjsm.2006.029769
Koester MC, Dunn WR, Kuhn JE, & Spindler KP (2007). The efficacy of subacromial corticosteroid injection in the treatment of rotator cuff disease: A systematic review. The Journal of the American Academy of Orthopaedic Surgeons, 15 (1), 3-11 PMID: 17213378
Related Resources
- b2d movement index
- why not train through pain?
- chronic low back pain - possible strategies
- What do omega 3's have to do with anti-inflammation?
- free your feet index - you might feel better.
Wednesday, April 21, 2010
Ankle Sprains: Tape, Bracing - doesn't matter finds research - but how'd we get so busted up in the first place?
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A recent paper has presented the results of a bunch of trials looking at interventions for ankle sprains. Main result? if someone's had an ankle injury - like a sprain - then tape or brace doesn't seem to show a difference: both seem to cut down reinjury. What's troublesome on a metalevel, is first how sort of accepted the notion of this level of injury seems to be, and second how nascent in the approach described here is the model that for folks who haven't been injured - as a preventitive - they maybe should be immobilised too. Aren't there other questions to ask - perhaps especially about the injury free staying injury free - rather than whether incapacitating natural function is a Good Idea? But perhaps more fundamentally, how did we get to this point where someone is so beaten up their joints are written off as so dysfunctional they must be immobilized to perform?
Here's the abstract:
So what's going on here that this is even considered a useful strategy?
Apparently, there's a lot of functional instability, mechanical and proprioceptive factors are also considered in some of the studies to be impaired. Mechanical instability (lax joint) can be a cause of functional instability. These effects build up from - you guessed it - repeated ankle injuries. Where reflexes get slower, joints can get hypermobile, funtional loss of static and dynamic support of the joint has gone way down. Effectively, the ankle for a potential variety of reasons, is so beaten up and abused, it can no long function as an ankle, so, a greater degree of immobility is preferable to too much.
Um. what happened that a person gets to this point of so MANY repeated injuries they're beyond the pale of recovering normal function? Ah right: this is sport, not health.
Intriguingly, there's a claim that some bracing helps proprioception:
There are alternatives approaches: perhaps we should ask, as indicated, what's causing these injuries in the first place? Is it a skills-on-the-field problem? turning skills? cognitive processing for field awareness skills? Is it lack of ankle flexion or hip/pelvis restrictions? Is it a sensory-motor disconnect with shoes or other gear killing proprioceptive awareness of foot placement?
Folks like Gray Cook working with NFL football teams have been looking at athletic mobility/stability. Eric Cobb has been looking more at sensory-motor approaches, and cognitive stress for field performance that's more effective and injury free.
Any solution assumes a model for which that solution is appropriate. The solutions proposed by these authors seems to presuppose a model where (a) the amount of reinjury that leads to such horrible dysfunction is taken as a given and seems to be ok such that (b) further bodily immobilization seems like a good idea to enable athletic movement seems problematic to me on a number of levels.
Strategies to understand why the injuries are so high in the first place - never mind acceptable - seems to be a more humane way to begin strategizing about enabling athltetes to play ball, no?
Related Posts
Citation
Dizon, J., & Reyes, J. (2010). A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players Journal of Science and Medicine in Sport, 13 (3), 309-317 DOI: 10.1016/j.jsams.2009.05.002 Tweet Follow @begin2dig
A recent paper has presented the results of a bunch of trials looking at interventions for ankle sprains. Main result? if someone's had an ankle injury - like a sprain - then tape or brace doesn't seem to show a difference: both seem to cut down reinjury. What's troublesome on a metalevel, is first how sort of accepted the notion of this level of injury seems to be, and second how nascent in the approach described here is the model that for folks who haven't been injured - as a preventitive - they maybe should be immobilised too. Aren't there other questions to ask - perhaps especially about the injury free staying injury free - rather than whether incapacitating natural function is a Good Idea? But perhaps more fundamentally, how did we get to this point where someone is so beaten up their joints are written off as so dysfunctional they must be immobilized to perform?Here's the abstract:
Epidemiological studies have shown that 10–28% of all sports injuries are ankle sprains, leading to the longest absence from athletic activity compared to other types of injuries. This study was conducted to evaluate the effectiveness of external ankle supports in the prevention of inversion ankle sprains and identify which type of ankle support was superior to the other. A search strategy was developed, using the keywords, ankle supports, ankle brace, ankle tapes, ankle sprains and athletes, to identify available literature in the databases (MEDLINE, PubMed, CINAHL, EMBASE, etc.), libraries and unpublished papers. Trials which consider adolescents and adults, elite and recreational players as participants were the study of choice. External ankle supports comprise ankle tape, brace or orthosis applied to the ankle to prevent ankle sprains. The main outcome measures were frequency of ankle sprains. Two reviewers assessed the quality of the studies included using the Joanna Briggs Institute (JBI Appraisal tool). Whenever possible, results were statistically pooled and interpreted. A total of seven trials were finally included in this study. The studies included were of moderate quality, with blinding as the hardest criteria to fulfill. The main significant finding was the reduction of ankle sprain by 69% (OR 0.31, 95% CI 0.18–0.51) with the use of ankle brace and reduction of ankle sprain by 71% (OR 0.29, 95% CI 0.14–0.57) with the use of ankle tape among previously injured athletes. No type of ankle support was found to be superior than the other.This is when it's nice to have the whole article, because you'd think it just stops there, right? For previously injured, folks who were taped didn't seem to get reinjured. How does one predict the future like that? Well that's the toughie: only one study had a control group - so did they just get reinjured that many more times than the athletes who braced? No, it's of the populations taped or braced, how many did NOT have a recurrence in a given period.
So what's going on here that this is even considered a useful strategy?
Apparently, there's a lot of functional instability, mechanical and proprioceptive factors are also considered in some of the studies to be impaired. Mechanical instability (lax joint) can be a cause of functional instability. These effects build up from - you guessed it - repeated ankle injuries. Where reflexes get slower, joints can get hypermobile, funtional loss of static and dynamic support of the joint has gone way down. Effectively, the ankle for a potential variety of reasons, is so beaten up and abused, it can no long function as an ankle, so, a greater degree of immobility is preferable to too much.
Um. what happened that a person gets to this point of so MANY repeated injuries they're beyond the pale of recovering normal function? Ah right: this is sport, not health.
Intriguingly, there's a claim that some bracing helps proprioception:
"they restrict range of motion to a certain degree and enhance proprioception of the injured ankle making them more useful in the prevention of possible re-injury."Wow, that's wild. How does that work? And can that awareness be re-trained rather than delivered only through a device? Where's it coming from? But there's not a lot of interest in the article in looking at say other strategies like rehab, movement assessment. Why not? There's a model here that says once injured, you're toasted:
As mentioned earlier in the discussion, after a sprain, structural damage occurs to the ligamentous tissues, nervous and musculo- tendinous units in the ankle joint. Functional and mechanical instability arise. For these reasons, the risk of injury to a pre- viously injured ankle is increased. his is the point where external ankle supports play an important role.And that may have informed the authors' decision simply to look at what type of bracing is better to reduce re-injury, rather than to wonder if
- training that can find movement or other sensory-motor issues that may be related to WHY a person roles their ankles
- investigation of the stupid shoes that may be killing proprioception necessary to reduce ankle sprains
- anything else that may help the athlete perform with less likelihood of injury, better performance
This review provides good evidence for the use either ankle taping or ankle braces to prevent lateral ankle sprains among previously injured players. However, for those with- out previous ankle injuries this still needs to be proven. There is no evidence on which external ankle support is better than the other. Each has its own advantages and disadvantages.You see it? These folks with this model of the weakness of the ankle - where "10-28%" of all athletic injuries occur - are already thinking MAYBE - we don't know yet - but maybe if we just brace the ankle up from the get go, we'll keep more ankles from being sprained.
There are alternatives approaches: perhaps we should ask, as indicated, what's causing these injuries in the first place? Is it a skills-on-the-field problem? turning skills? cognitive processing for field awareness skills? Is it lack of ankle flexion or hip/pelvis restrictions? Is it a sensory-motor disconnect with shoes or other gear killing proprioceptive awareness of foot placement?
Folks like Gray Cook working with NFL football teams have been looking at athletic mobility/stability. Eric Cobb has been looking more at sensory-motor approaches, and cognitive stress for field performance that's more effective and injury free.
Any solution assumes a model for which that solution is appropriate. The solutions proposed by these authors seems to presuppose a model where (a) the amount of reinjury that leads to such horrible dysfunction is taken as a given and seems to be ok such that (b) further bodily immobilization seems like a good idea to enable athletic movement seems problematic to me on a number of levels.
Strategies to understand why the injuries are so high in the first place - never mind acceptable - seems to be a more humane way to begin strategizing about enabling athltetes to play ball, no?
Related Posts
Citation
Dizon, J., & Reyes, J. (2010). A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players Journal of Science and Medicine in Sport, 13 (3), 309-317 DOI: 10.1016/j.jsams.2009.05.002 Tweet Follow @begin2dig
Monday, January 11, 2010
Not Time of Day for Training but Location Location Location
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The question of time of day for training has been asked often. Better to train at night? better to train in the morning? Better for anaerobic? better for aerobic?
Indeed, one of my fave current studies has shown that the circadian clock is th
readed right into the muscles - at least of mice
So this all sounds like business as usual - a little dubious - but heh we still don't know about diurnal effects on training. One other contemporary study suggests well, we know more now than we thought we did, because we varied a usually stable/assumed variable in the study: location. And then lots of things shifted.
In other words, it seems that time of day makes no significant difference to results on a test.
THe authors provide a really nice review of about half a dozen key studies that have looked at time of day and training effect. So why didn't that happen here? Here's what the authors' postulate: weather, light, location. External rather than internal factors.
I love speculation in research papers! something that says we have this finding that's different from other people's and we're trying to figure out A. what the differences are between our set ups and B. why those differences might have an effect. Temperate vs Tropic. Long daylight vs not.
So even here to say "time of day doesn't matter" for training has to have a caveat attached - depending on WHERE and what time of year you may be training. And that's a cool result
Hope the above helps offer one more reason that hitting the tropics is a good idea for health and well-being.
Related Posts:
The question of time of day for training has been asked often. Better to train at night? better to train in the morning? Better for anaerobic? better for aerobic?Indeed, one of my fave current studies has shown that the circadian clock is th
readed right into the muscles - at least of miceJ Appl Physiol. 2009 Nov;107(5):1647-54. Epub 2009 Aug 20.Working around the clock: circadian rhythms and skeletal muscle.
Center for Muscle Biology, Dept. of Physiology, Chandler College of Medicine, Univ. of Kentucky, 800 Rose St., Lexington, KY 40536, USA.The study of the circadian molecular clock in skeletal muscle is in the very early stages. Initial research has demonstrated the presence of the molecular clock in skeletal muscle and that skeletal muscle of a clock-compromised mouse, Clock mutant, exhibits significant disruption in normal expression of many genes required for adult muscle structure and metabolism. In light of the growing association between the molecular clock, metabolism, and metabolic disease, it will also be important to understand the contribution of circadian factors to normal metabolism, metabolic responses to muscle training, and contribution of the molecular clock in muscle-to-muscle disease (e.g., insulin resistance). Consistent with the potential for the skeletal muscle molecular clock modulating skeletal muscle physiology, there are findings in the literature that there is significant time-of-day effects for strength and metabolism. Additionally, there is some recent evidence that temporal specificity is important for optimizing training for muscular performance. While these studies do not prove that the molecular clock in skeletal muscle is important, they are suggestive of a circadian contribution to skeletal muscle function. The application of well-established models of skeletal muscle research in function and metabolism with available genetic models of molecular clock disruption will allow for more mechanistic understanding of potential relationships.
So this all sounds like business as usual - a little dubious - but heh we still don't know about diurnal effects on training. One other contemporary study suggests well, we know more now than we thought we did, because we varied a usually stable/assumed variable in the study: location. And then lots of things shifted.
J Strength Cond Res. 2010 Jan;24(1):23-9.Effects of 5 weeks of training at the same time of day on the diurnal variations of maximal muscle power performance.
Laboratory ACTES, UFR STAPS-Université Antilles-Guyane, Campus de Fouillole, Pointe-à -Pitre, France. stephen.blonc@univ-ag.frThe purpose of this study was to investigate whether maximal muscle power production in humans is influenced by the habitual time of training to provide recommendations for adapting training hours in the month preceding a competition. Sixteen participants performed maximal brief squat and countermovement jumps and short-term cycle sprints tests before and after 5 weeks of training. Subjects were randomly assigned to either a Morning-Trained Group (MTG, 7:00-9:00 hr) or an Evening-Trained Group (ETG, 17:00-19:00 hr). They trained and performed the evaluation tests in both the morning and evening in their naturally warm and moderately humid environment. The results indicated a significant increase in performance (approximately 5-6% for both tests) after training for both groups but failed to show any time-of-day effect on either performance or training benefit. These findings could be linked to the stabilization of performances throughout the day because of the passive warm-up effect of the environment. In summary, our data showed that anaerobic muscle power production could be performed at any time of day with the same benefit.
In other words, it seems that time of day makes no significant difference to results on a test.
THe authors provide a really nice review of about half a dozen key studies that have looked at time of day and training effect. So why didn't that happen here? Here's what the authors' postulate: weather, light, location. External rather than internal factors.
In our study, the lack of difference between morning and evening training could be explained in part by the moderately warm and humid environmental conditions, in which the natural light remains similar from 6:00 to 18:00 hours. Previous studies conducted in our laboratory in a moderately warm environment failed to show any daytime variations in anaerobic performance (31,32). Moreover, this particular tropical environment changes little over the entire year, with few variations in temperature. The passive warm-up effect of this environment has been suggested to blunt the passive warm-up effect of time of day (32). This may thus lead to specific physiologic adaptations to exercise (3) and certainly influences the circadian regulation of some neurohormonal metabolisms. It might have acted as a stabilizer, and the results of the good intraclass correlations for the CMJ as well as the good to very good test-retest correlations for all jumps support this point. Indeed, previous studies conducted in the same environment showed a stability in performance throughout the day, and the training benefit thus appears as strong at any time of day.This is an important observation because, up to now, such stability has only been shown for short-term acute but not chronic exercise. Moreover, it is particularly interesting when improved maximal muscle power performance is sought because training should be carried out at the time of day when performance is highest and maximal (30).
I love speculation in research papers! something that says we have this finding that's different from other people's and we're trying to figure out A. what the differences are between our set ups and B. why those differences might have an effect. Temperate vs Tropic. Long daylight vs not.So even here to say "time of day doesn't matter" for training has to have a caveat attached - depending on WHERE and what time of year you may be training. And that's a cool result
Hope the above helps offer one more reason that hitting the tropics is a good idea for health and well-being.
Related Posts:
- Athletic Bodies: which one is yours?
- Fitness article index
- nurtition article index
- kettlebell training articles
Zhang, X., Dube, T., & Esser, K. (2009). Working around the clock: circadian rhythms and skeletal muscle Journal of Applied Physiology, 107 (5), 1647-1654 DOI: 10.1152/japplphysiol.00725.2009Tweet Follow @begin2dig
Blonc S, Perrot S, Racinais S, Aussepe S, & Hue O (2010). Effects of 5 weeks of training at the same time of day on the diurnal variations of maximal muscle power performance. Journal of strength and conditioning research / National Strength & Conditioning Association, 24 (1), 23-9 PMID: 19966592
Sunday, August 2, 2009
Sedona Method Review 5 Months On: What if what you're doing right now is exactly the right thing to do?
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Overview: What's in this Sedona Method review
The following is a detailed review/overview of the Sedona Method. It's an evaluation, too, five months on from first exploring it . So what is the Sedona Method about? The sedona method, as the program states, is an easy, powerful and repeatable method for enhancing quality of life. Its main premise seems to be that we hang onto a lot of crap that makes us miserable - mainly emotions. If we learn how to let go of the crap we generate, we can see the actual situation more clearly, effectively and effortlessly, leaving us free to make choices, plans or what it calls Right Actions. The effect of this new perspective is to be more relaxed, happy, and fluid in our daily lives. That promise is what's on the tin, and it is definitely what the Sedona Method (SM) delivers.
And just to be explicit about what's on the tin, quoting from the manual, practice of the SM enables:
The thing is, that since going through just a month or so of real practice with this stuff, going to meetings at work that would previously have had me in a state enabled me instead to go in with well what? an easiness about expectations and outcomes that i'd not experienced before. And it was good. Very good. The results of that shift have been profound. And yes profound on a number of levels, including income and opportunity.
That more laughter, openness and flexibility stuff that has happened without thinking about it - it's just a side effect - has turned out to be HUGE - at least for me. I had no idea how heavy normal stuff had been on me until i started putting it down - or to use the SM terminology - letting go of it.
The other important thing here is that it didn't take any time to have an effect. This stuff can work instantly.
For instance, i was able to apply lessons from the Effortless Relationships programs to work and home relationship situations as soon as i'd gone through the related exercises on the disks. The speed at which these transformations occurred had those nearest to me asking what drugs i was on - especially regarding stuff they knew previously would have had me utterly in a tizzy and that was now well, just whatever it was. I wasn't taking it on.
The best way i have to describe the effect is that the Sedonam Method offers a perspective shift.
The perspective shift is from steamed, grimed up windows in a boiler room of stress and concern to the super clear intense perception of colour and form one gets when jumping out of an airplane (trust me). As soon as the shoot opens, time slows and everything takes on a sharper brighter focus and it's kind of exhilerating.
The key to this paradigm shift is the fundamental principle of SM: letting go. SM doesn't say, however, let go of goals for success, wealth, whatever and live like a monk - unless you want to do that. It really is about what happens to these desires if they're not cluttered and decorated with all sorts of emotions like stress and fear and longing and anger and lust? They may still be there, but perhaps they will be shaped differently and our approach to them may be different.
For example, what if we come to a desire with an abundance mentality rather than a scarcity mentality? To me anyway, that single shift from fear that this is the only opportunity for something to a sense that in a practically infinite universe, there is an abundance of opportunity, tends to take the urgency level down as well as the killer instinct stuff down.
Part of the Sedona Method is to learn how to move towards an abundance mentality in a way that's safe. That alone can be a big shift but really, making it really and truly does let way more good stuff in.
And the folks who designed this program understand that exploring, little own making, these kinds of paradigm shifts can be intense. Hence the programs are designed to support the process of making those shifts. It's in respect of this process that what's offered - what you purchase - is the real deal: the tools a person needs to assess the material and move through the steps progressively.
The rest of this review is to overview what's in the pacakge and how what's in the package can work. The cool thing for me is that i know enough people who have purchased these courses based on our discussions about SM that i've seen, it seems, everyone approaches the material and working throug it a little differently - and it's all good. So here we go.
The Stuff in the Tin
Just a note - i get nothing - no affiliate ties - from any of your link clicks - this is just an overview to help justify what to me is a big cost.
The package includes 20CDs and a large binder with the 200 page manual.
The CD's make up about 21 hours of material over four courses: (1) the Sedona Method (2) Effortless Wealth and Success (3) Effortless Relationships and (4) Effortless Health and Well-Being.
Some folks have commented to me wow that's a lot of material - i don't think i can do that. My reply is generally, think of any good courses you've been on. The RKC certification weekend for instance is 21hours of instruction and drills for practice. The Franklin Covey leadership courses, likewise 3-4 days of learning and practicum. The approach here is exactly the same. So let's look at that.
The approach
Audio Program. These disks are in large part taken from recordings of real courses that are taught in, appropriately enough, Sedona Arizona. The format of the programs is that the presentor, Hale Dwoskin, introduces a concept, takes questions from participants, responds, and then offers a follow along drill to operationalize the concept being explored. These drills may be repeated a few times, which is great because it means that a concept gets PRACTICED with the course leader.
Manual. The manual supports each CD, re-viewing and representing the concepts explored on each disk, and, where appropriate, providing graphics to illustrate a concept. Likewise, notes spaces are provided too, as this is very much a course, and sometimes participants will be asked "So write down in your notebook some of your health related goals" or "write down the words that occur to you when..." and it DOES make a difference when one writes something down rather than not.
If like some of us, the goal is to keep the manual pristine, it's easy to slot in some blank pages.
Learning Styles
Personally, i didn't look at the manual when i got the course. The files were rapidly uploaded to an ipod, and i went through all the concepts on all the disks, entirely skipping all the exercises. I didn't want to do them; i wanted to get where this course was going. In reality it wasn't till i was struck down with the worst cold of my life and couldn't move - was supposed to be at a conference in fact - that i put the headphones on and listened again this time doing each of the exercises. Life changing experience. In a better state of mind when i got home, i then went through the material again, actually hitting replay quite a bit on some of the tracks that were of most interest to my process at that time.
Me, i do all my listening mainly at two times of the day: at night, before i go to sleep, and then in the am when i'm rowing or biking (stationary, both) The morning slots are generally to repeat something i've listened to before as i get pretty caught up in the activity, and can miss stuff.
In contrast, other people i know wouldn't listen to the CD's until they've read the manual cover to cover. Others listen to a CD as they're driving, and connect with the manual when they get home.
One recommendation: as each program builds on the previous one, going through the material linearly seems to be a good idea.
The Courses
The Sedona Method. SM is the first course presented. This gives an overview of the history to the method - interesting stuff - and then gets into what it actually is about. Here's where the SM basics are laid out and practiced.
This initial program presents the SM approach to Letting Go in particular in relation to our connexion first with problems and then the emotional baggage that makes problems so sticky. It moves through a hierarchy of emotions that hold us back rather than lifting us up - emotions like apathy, grief, fear, lust, anger, pride - and believe it or not, courageousness, acceptance and peace. That last one was a particular surprise: what, there's more after inner peace? there's a stickiness problem with peace? The reasons why there are a few issues with peace attachment are both challenging and compelling.
Resistance. Once we have these emotions tidied up, the prorgam looks at issues around resistance to letting go, featuring on one of my favorite intriguing words: want.
Want. The full definition of Want includes Lack. A want is a lack. So the SM spends time looking at approaches around "allowing oneself" something rather than "wanting something." Those wants include both wanting to have and wanting to figure stuff out. Dwoskin says around problems repeatedly "the only reason we want to figure out a problem is if we're planning to have it again." Such a statement can be quite challenging, but the challenge here is to say, what if there a way to let go of the emotions like want around something and see what happens? IF you don't like the result, you can always go back to where you were. But the constant framing of SM is "allow yourself to...just in this moment...as best as you can"
There is nothing scary here or threatening: allow yourself to let go of feeling afraid, just in THIS moment. Could you do this? would you let yourself do this? when? how about now, and just for now?
That small window of opportunity to safely explore imaginatively how something might be, if it didn't have to be loaded with fear, grief, loss, lust makes for a pretty incredible moment - that participants can decide to continue or abandon whenever they/we wish.
Indeed, a lot of the last part of this course is around issues of wanting relative to survival and security and fears of being alone or its inverse, and even of letting go of wanting to get away from all the crap. Amazing.
Skills Summary. So in this first course a person gains the skills to get a handle on what emotions come up around *stuff* that triggers us, makes us *feel* something. These feelings - becoming aware of them - are signals to see if there's an opportunity to explore letting go, or if there's resistance to letting go, and intriguingly NOT looking at why we don't want to let go, but just releasing the stuff to see what's there.
From here the program heads to the second Course.
Effortless Wealth and Success.
A stat i heard once and can't recall where is that most businesses fail because they're not prepared for success. This seems kind of applicable in an inverse way to the Effortless Wealth and success course. Another way to frame this program is perhaps as the Goals Course, and it's certainly the one that resonated with me the most when i wrote a preliminary SM review a few months ago - hence the "getting rid of crap" around goals.
The key thing - at least for me - in the Effortless Wealth and Success course is the concept of what happens when we shift from coming from scarcity to coming from abundance, and even further from Scarcity to Enough.
The program recognizes that there is real fear and anxiety around our wealth and success stuff. We need, in maslov's terms, food and shelter. Most of us once we have that, start wanting more stuff and we assess ourselves according to those stuff-y achievements. So there are a lot of excercises around what it means to move through the real fear of the scarcity model into the Abundance and Enough models.
Lest i give the wrong impression, the SM is very practical. It has in this section alone, powerful drills on assessing advantages and disadvantages of a particular goal we're going for, and of letting go of wanting to be right.
As noted in my preliminary review of the SM, the approach also kicks the can of "positive visualization" as rather more escapist than practical and talks about Goal Action Steps, so those up on their SMART steps for goals needn't worry. The main thing is to make sure the goal one is going after is one's own.
There's a lot of applications of this course not just in money wealth generation but other models of effort. Awhile ago i was working on my pistols and really getting into grr focus, super challenging, grr. and then i thought wait, effortless - what if i approached this from an abundance perspective: there are many pistols to be had. Well, i pulled off considerably more than i had before. Like a lot
Meanwhile, a rower i'd suggested might find the SM helpful with some stressors in her life said she was all keyed up about a race, hadn't been sleeping. She finally got to a place doing the method excercises of what's called becomeing "hootlees" - where you get to a place with a goal that it doesn't matter if you achieve it or not - you're still going for it, but it doesn't matter the outcome. And (a) she fell asleep immediately and won her race the next day.
One can say she won because she got some rest and was relaxed. Yes absolutely. But that's sort of the point: she found a way to get to that very healthy positive place that LET her optimize recovery and LET her body do its practice - effortlessly, beautifully.
Effortless Relationships
Oh my, if one section in this course has helped me personally the most quickly it's been this one. I dunno about you, but i have been filled with situation where i have felt if only i could get people to see my side of things the world would be better. Or where i have felt that one person just drops poison into part of my world. The result is constant low-grade persistent frustration at not being able to control the situation, the people or the outcomes. Indeed, one of the repeated questions in the SM is is that whatever is wanting approval, control, separation or oneness?
And before trying to get away from whatever one is feeling, can we welcome it? could we let go of wanting to change it?
Indeed, that's a biggie: to let go of wanting to control someone (or being controlled by someone) and loving them as they are.
Again, the exercises in this section are really powerful. I can say that in practicing them - some times repeatedly. a lot. to get to that let go of place with thinking about various people - while i didn't go hug them the next time i saw them (this is England), i did feel a lot more relaxed, more able to listen to them, less invested in outcomes (i have other options; abundance mentality) and things have been easier.
These skills are rapidly transferable. The cool thing in these skills is that practiced once for one relationship, they are immeidiately applicable to another, and the more frequently practiced, the more rapid the transition from GRRR to oh. ok. done with that. smile. listening. It's quite stunning.
Perhaps one of the best examples i have of this is that a student of mine came by to discuss work and had said words to the effect that he'd anticipated it was going to be a negative experience - our last meeting had been a bit fraught - and instead it was really positive and he was glad he'd come over. I thought, ya, well, that's great. My perspective is certainly different and isn't it cool that that's helpful for someone i'm supposed to be coaching towards a goal? Right on.
Effortless Health and Well being
In a way i personally have found this to be the most challenging of the courses. While its about dealing with health - and when i first listend thoroughly to this section i was as sick as a dog - it's also about what all the SM is about - welcoming in wherever we are now before letting go to get higher up and further in.
This welcoming can be challenging, perhaps especially for those who make a part of their life focus around physical well being. Can we accept our bodies exactly as they are now? Is there guilt or shame up around anything related to our physical beings? how do we deal with that?
And what about dis-ease? The SM does not promise to heal one's disease - though i have heard of colleagues who have killed colds and other ailments practicing these exercises. What it does help with is to let go of the stuff up around disease, including pain.
Again this latter one may seem hard to believe, but in looking at the neurophysiology of pain (and the book Explain Pain is a great overview), we know that pain is a signal, and that context has a great deal to do with how that signal is amped up or down. And that that response can have a profound effect on well-being.
I do not have a great deal of direct experience applying these exercises to health issues like an illness or a disease. I would be keen to hear from folks who have. Where i have had benefit is around fitness issues related to previous impatience around what i've perceived as a lack of progress in a timely and optimal way. The action steps for well-being here, combined with the lessons from the Success/Goals course have been very helpful in letting go of the crap sufficiently to be able to assess my practice, get additional information where necessary and to tune.
Wrap up
The final disk of the SM is a wrap up and a look forward. Folks are encouraged to practice this stuff and where there are opportunities, bring it into their organizations.
For me, this has meant sharing this approach with the students and athletes with whom i work, and with my colleagues and especially with folks i meet in places like this blog.
Practice: All the Time in the World
I've had a few folks ask me "so are you still doing that method?" The answer is yes. Indeed, as said, i'm a fan of the approach, in particular the exercises that are so related to particular circumstances. As folks who have ordered the SM and followed up with me will atest, if they have questions like "is there something i can listen to that might help with X" - a reply with "yes CD A Track B" comes back pretty quickly - normally cuz i've struggled with these things myself. Certain parts of the ipod's drive must be ground in by now.
A suggestion is that it really helps to make the course a priority for a weekend. Plan it as a retreat. I was luck: i got struck down by germs and could do nothing else. If i hadn't i'm not sure i would have had the results i did as quickly as i did in finding a path into this stuff. After that initial three day burst to go through everything, i spend the next couple months repeating areas at night or, as said, while doing intervals (or while on trains to meetings).
Indeed, the blend of instruction, discussion and practicum is very good: it makes picking what's best for the moment very straight forward and practical/practicable.
Most earth shattering take away:
For me that one question has been pretty revolutionary and it came after i'd gone through the sedonam method disks what was likely a couple of times. I was still having some stuff up around judgements of myself not seeming to get certain things done that i "should" be doing (should quickly becomes a flag to investigate further).
If we allow ourselves to consider the possibility that what we are doing right now is exactly right, i have found anyway, that a whole lot more crap falls away, enabling even more possibilities and less stress.
Now we know from so much related work in health and phsiology that a steady diet of stress is a Bad Thing. It literally wears us away with oxidative stress, ie rust. Being stressed effects our sleep our diet how are bodies process sugar all sorts of stuff. So if there are approaches that help us let go of stress - even the imaginary stress of "should" then the release that occurs from this alone for our health is substantial.
Personally, i feel better - i feel that
One more note on practice - it is a practice. Like anything else with our brains, i've found the SM is a kind of use it or lose it. While i'd become so familiar with the CD's i didn't feel i could listen to them again, after several weeks' pause, I've recently gone back to refreshing the concepts right from scratch, and it's been very good to do so. What triggered the need is feeling myself getting caught up in some shoulding and not quite feeling the positive feelings i had. So i want to perk that up a bit again. And it's working. It's good to go over the drills as a refressher - ah yes - this is the way of letting go here.
Bonus Bliss
Yes, i can honestly say that with some of the final exercises, along with another SM product called the Bliss Mini Retreat - i have felt that bliss experience that we hear about from letting go and getting to that higher place where everything is connected. It happened while waiting for a flight and listening to the follow along "allow yourself to..." guidance. It then happened listening again while getting a ride into a conference venue.
It's pretty cool. It's pretty joyful - and something to let go of as well, but in a good way. It's nice to know that without having to leave the world and study for a lifetime, one can with a bit of practice on these courses, hit the ipod and literally bliss out. It's quite the recharge.
Value for Money
SO, all in all, the Sedona Method is great value for money. Also the guarantee is 100% refund within 6 months if you want to send it back.
But that's just price. It's equivalent to a three day course in materials, but an n'th of the cost. It's structure is that of the best of breed three day course, and while they cannot say due to legalize that practicing the SM results in health benefits, i can say that in my own experience that its practical, pragmatic approach to looking at one's crap in a way to let go of it such that one can become a more functional, concurrently de-stressed, more joyful person, means that one has improved well-being.
Even for my grad students - students always being poor - this is excellent value for money - why? Stress and emotional turmoil is the lot of too many students trying to complete their degrees - especially advanced degrees. Anything that can legally help a person see more clearly, focus, get work done, is a good thing. Without this foundation, all the time management strategies in the world won't work: they have no stable surface on which to work.
Likewise for athletes: stress at the right moment has been said to be useful to achieve a result. In watching the best of the best athletes however, the ones who *seem* to be relaxed and open seem to perform with excellence. I'm thinking of for instance Usain Bolt's 100m sprint last year at the olympics. Or Roger Federer's and even Andy Roddick's open swings on the court of the Wimbleton final.
The SM seems to offer a variety of mental strategies to cut through the dross and get to the heart of what matters, and let that material sing. Healthy, wealthy, well.
In my experience, these are all good things, and the SM has proven a great accelerator to experience them.
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The following is a detailed review/overview of the Sedona Method. It's an evaluation, too, five months on from first exploring it . So what is the Sedona Method about? The sedona method, as the program states, is an easy, powerful and repeatable method for enhancing quality of life. Its main premise seems to be that we hang onto a lot of crap that makes us miserable - mainly emotions. If we learn how to let go of the crap we generate, we can see the actual situation more clearly, effectively and effortlessly, leaving us free to make choices, plans or what it calls Right Actions. The effect of this new perspective is to be more relaxed, happy, and fluid in our daily lives. That promise is what's on the tin, and it is definitely what the Sedona Method (SM) delivers.
And just to be explicit about what's on the tin, quoting from the manual, practice of the SM enables:
- Greater ease, effeciveness and joy in daily activities
- An increase in positive feelings
- A decrease in negative feelings
- More love towards one's self and other
- Positive changes in behaviour and or attitude
- More open and effective communications
- Increased problem-solving ability
- more laughter
- greater openneness and flexibility
- Clearer reason and more natural intuitive knowing
- Being more relaxed and confident in action and at rest
- Accomplishments and completions
- New beginnings
- greater ease in aquiring new abilities or skills.
The thing is, that since going through just a month or so of real practice with this stuff, going to meetings at work that would previously have had me in a state enabled me instead to go in with well what? an easiness about expectations and outcomes that i'd not experienced before. And it was good. Very good. The results of that shift have been profound. And yes profound on a number of levels, including income and opportunity.That more laughter, openness and flexibility stuff that has happened without thinking about it - it's just a side effect - has turned out to be HUGE - at least for me. I had no idea how heavy normal stuff had been on me until i started putting it down - or to use the SM terminology - letting go of it.
The other important thing here is that it didn't take any time to have an effect. This stuff can work instantly.
For instance, i was able to apply lessons from the Effortless Relationships programs to work and home relationship situations as soon as i'd gone through the related exercises on the disks. The speed at which these transformations occurred had those nearest to me asking what drugs i was on - especially regarding stuff they knew previously would have had me utterly in a tizzy and that was now well, just whatever it was. I wasn't taking it on.
The best way i have to describe the effect is that the Sedonam Method offers a perspective shift.
The perspective shift is from steamed, grimed up windows in a boiler room of stress and concern to the super clear intense perception of colour and form one gets when jumping out of an airplane (trust me). As soon as the shoot opens, time slows and everything takes on a sharper brighter focus and it's kind of exhilerating.
The key to this paradigm shift is the fundamental principle of SM: letting go. SM doesn't say, however, let go of goals for success, wealth, whatever and live like a monk - unless you want to do that. It really is about what happens to these desires if they're not cluttered and decorated with all sorts of emotions like stress and fear and longing and anger and lust? They may still be there, but perhaps they will be shaped differently and our approach to them may be different.
For example, what if we come to a desire with an abundance mentality rather than a scarcity mentality? To me anyway, that single shift from fear that this is the only opportunity for something to a sense that in a practically infinite universe, there is an abundance of opportunity, tends to take the urgency level down as well as the killer instinct stuff down.
Part of the Sedona Method is to learn how to move towards an abundance mentality in a way that's safe. That alone can be a big shift but really, making it really and truly does let way more good stuff in.
And the folks who designed this program understand that exploring, little own making, these kinds of paradigm shifts can be intense. Hence the programs are designed to support the process of making those shifts. It's in respect of this process that what's offered - what you purchase - is the real deal: the tools a person needs to assess the material and move through the steps progressively.
The rest of this review is to overview what's in the pacakge and how what's in the package can work. The cool thing for me is that i know enough people who have purchased these courses based on our discussions about SM that i've seen, it seems, everyone approaches the material and working throug it a little differently - and it's all good. So here we go.
The Stuff in the Tin
Just a note - i get nothing - no affiliate ties - from any of your link clicks - this is just an overview to help justify what to me is a big cost.
The package includes 20CDs and a large binder with the 200 page manual.
The CD's make up about 21 hours of material over four courses: (1) the Sedona Method (2) Effortless Wealth and Success (3) Effortless Relationships and (4) Effortless Health and Well-Being.Some folks have commented to me wow that's a lot of material - i don't think i can do that. My reply is generally, think of any good courses you've been on. The RKC certification weekend for instance is 21hours of instruction and drills for practice. The Franklin Covey leadership courses, likewise 3-4 days of learning and practicum. The approach here is exactly the same. So let's look at that.
The approach
Audio Program. These disks are in large part taken from recordings of real courses that are taught in, appropriately enough, Sedona Arizona. The format of the programs is that the presentor, Hale Dwoskin, introduces a concept, takes questions from participants, responds, and then offers a follow along drill to operationalize the concept being explored. These drills may be repeated a few times, which is great because it means that a concept gets PRACTICED with the course leader.
Manual. The manual supports each CD, re-viewing and representing the concepts explored on each disk, and, where appropriate, providing graphics to illustrate a concept. Likewise, notes spaces are provided too, as this is very much a course, and sometimes participants will be asked "So write down in your notebook some of your health related goals" or "write down the words that occur to you when..." and it DOES make a difference when one writes something down rather than not.
If like some of us, the goal is to keep the manual pristine, it's easy to slot in some blank pages.
Learning Styles
Personally, i didn't look at the manual when i got the course. The files were rapidly uploaded to an ipod, and i went through all the concepts on all the disks, entirely skipping all the exercises. I didn't want to do them; i wanted to get where this course was going. In reality it wasn't till i was struck down with the worst cold of my life and couldn't move - was supposed to be at a conference in fact - that i put the headphones on and listened again this time doing each of the exercises. Life changing experience. In a better state of mind when i got home, i then went through the material again, actually hitting replay quite a bit on some of the tracks that were of most interest to my process at that time.
Me, i do all my listening mainly at two times of the day: at night, before i go to sleep, and then in the am when i'm rowing or biking (stationary, both) The morning slots are generally to repeat something i've listened to before as i get pretty caught up in the activity, and can miss stuff.
In contrast, other people i know wouldn't listen to the CD's until they've read the manual cover to cover. Others listen to a CD as they're driving, and connect with the manual when they get home.
One recommendation: as each program builds on the previous one, going through the material linearly seems to be a good idea.
The Courses
The Sedona Method. SM is the first course presented. This gives an overview of the history to the method - interesting stuff - and then gets into what it actually is about. Here's where the SM basics are laid out and practiced.
This initial program presents the SM approach to Letting Go in particular in relation to our connexion first with problems and then the emotional baggage that makes problems so sticky. It moves through a hierarchy of emotions that hold us back rather than lifting us up - emotions like apathy, grief, fear, lust, anger, pride - and believe it or not, courageousness, acceptance and peace. That last one was a particular surprise: what, there's more after inner peace? there's a stickiness problem with peace? The reasons why there are a few issues with peace attachment are both challenging and compelling.
Resistance. Once we have these emotions tidied up, the prorgam looks at issues around resistance to letting go, featuring on one of my favorite intriguing words: want.
Want. The full definition of Want includes Lack. A want is a lack. So the SM spends time looking at approaches around "allowing oneself" something rather than "wanting something." Those wants include both wanting to have and wanting to figure stuff out. Dwoskin says around problems repeatedly "the only reason we want to figure out a problem is if we're planning to have it again." Such a statement can be quite challenging, but the challenge here is to say, what if there a way to let go of the emotions like want around something and see what happens? IF you don't like the result, you can always go back to where you were. But the constant framing of SM is "allow yourself to...just in this moment...as best as you can"
There is nothing scary here or threatening: allow yourself to let go of feeling afraid, just in THIS moment. Could you do this? would you let yourself do this? when? how about now, and just for now?
That small window of opportunity to safely explore imaginatively how something might be, if it didn't have to be loaded with fear, grief, loss, lust makes for a pretty incredible moment - that participants can decide to continue or abandon whenever they/we wish.
Indeed, a lot of the last part of this course is around issues of wanting relative to survival and security and fears of being alone or its inverse, and even of letting go of wanting to get away from all the crap. Amazing.
Skills Summary. So in this first course a person gains the skills to get a handle on what emotions come up around *stuff* that triggers us, makes us *feel* something. These feelings - becoming aware of them - are signals to see if there's an opportunity to explore letting go, or if there's resistance to letting go, and intriguingly NOT looking at why we don't want to let go, but just releasing the stuff to see what's there.
From here the program heads to the second Course.
Effortless Wealth and Success.
A stat i heard once and can't recall where is that most businesses fail because they're not prepared for success. This seems kind of applicable in an inverse way to the Effortless Wealth and success course. Another way to frame this program is perhaps as the Goals Course, and it's certainly the one that resonated with me the most when i wrote a preliminary SM review a few months ago - hence the "getting rid of crap" around goals.The key thing - at least for me - in the Effortless Wealth and Success course is the concept of what happens when we shift from coming from scarcity to coming from abundance, and even further from Scarcity to Enough.
The program recognizes that there is real fear and anxiety around our wealth and success stuff. We need, in maslov's terms, food and shelter. Most of us once we have that, start wanting more stuff and we assess ourselves according to those stuff-y achievements. So there are a lot of excercises around what it means to move through the real fear of the scarcity model into the Abundance and Enough models.
Lest i give the wrong impression, the SM is very practical. It has in this section alone, powerful drills on assessing advantages and disadvantages of a particular goal we're going for, and of letting go of wanting to be right.
As noted in my preliminary review of the SM, the approach also kicks the can of "positive visualization" as rather more escapist than practical and talks about Goal Action Steps, so those up on their SMART steps for goals needn't worry. The main thing is to make sure the goal one is going after is one's own.
There's a lot of applications of this course not just in money wealth generation but other models of effort. Awhile ago i was working on my pistols and really getting into grr focus, super challenging, grr. and then i thought wait, effortless - what if i approached this from an abundance perspective: there are many pistols to be had. Well, i pulled off considerably more than i had before. Like a lot
Meanwhile, a rower i'd suggested might find the SM helpful with some stressors in her life said she was all keyed up about a race, hadn't been sleeping. She finally got to a place doing the method excercises of what's called becomeing "hootlees" - where you get to a place with a goal that it doesn't matter if you achieve it or not - you're still going for it, but it doesn't matter the outcome. And (a) she fell asleep immediately and won her race the next day.
One can say she won because she got some rest and was relaxed. Yes absolutely. But that's sort of the point: she found a way to get to that very healthy positive place that LET her optimize recovery and LET her body do its practice - effortlessly, beautifully.
Effortless Relationships
Oh my, if one section in this course has helped me personally the most quickly it's been this one. I dunno about you, but i have been filled with situation where i have felt if only i could get people to see my side of things the world would be better. Or where i have felt that one person just drops poison into part of my world. The result is constant low-grade persistent frustration at not being able to control the situation, the people or the outcomes. Indeed, one of the repeated questions in the SM is is that whatever is wanting approval, control, separation or oneness?
And before trying to get away from whatever one is feeling, can we welcome it? could we let go of wanting to change it?
Indeed, that's a biggie: to let go of wanting to control someone (or being controlled by someone) and loving them as they are.
Again, the exercises in this section are really powerful. I can say that in practicing them - some times repeatedly. a lot. to get to that let go of place with thinking about various people - while i didn't go hug them the next time i saw them (this is England), i did feel a lot more relaxed, more able to listen to them, less invested in outcomes (i have other options; abundance mentality) and things have been easier.
These skills are rapidly transferable. The cool thing in these skills is that practiced once for one relationship, they are immeidiately applicable to another, and the more frequently practiced, the more rapid the transition from GRRR to oh. ok. done with that. smile. listening. It's quite stunning.
Perhaps one of the best examples i have of this is that a student of mine came by to discuss work and had said words to the effect that he'd anticipated it was going to be a negative experience - our last meeting had been a bit fraught - and instead it was really positive and he was glad he'd come over. I thought, ya, well, that's great. My perspective is certainly different and isn't it cool that that's helpful for someone i'm supposed to be coaching towards a goal? Right on.
Effortless Health and Well being
In a way i personally have found this to be the most challenging of the courses. While its about dealing with health - and when i first listend thoroughly to this section i was as sick as a dog - it's also about what all the SM is about - welcoming in wherever we are now before letting go to get higher up and further in.
This welcoming can be challenging, perhaps especially for those who make a part of their life focus around physical well being. Can we accept our bodies exactly as they are now? Is there guilt or shame up around anything related to our physical beings? how do we deal with that?
And what about dis-ease? The SM does not promise to heal one's disease - though i have heard of colleagues who have killed colds and other ailments practicing these exercises. What it does help with is to let go of the stuff up around disease, including pain.Again this latter one may seem hard to believe, but in looking at the neurophysiology of pain (and the book Explain Pain is a great overview), we know that pain is a signal, and that context has a great deal to do with how that signal is amped up or down. And that that response can have a profound effect on well-being.
I do not have a great deal of direct experience applying these exercises to health issues like an illness or a disease. I would be keen to hear from folks who have. Where i have had benefit is around fitness issues related to previous impatience around what i've perceived as a lack of progress in a timely and optimal way. The action steps for well-being here, combined with the lessons from the Success/Goals course have been very helpful in letting go of the crap sufficiently to be able to assess my practice, get additional information where necessary and to tune.
Wrap up
The final disk of the SM is a wrap up and a look forward. Folks are encouraged to practice this stuff and where there are opportunities, bring it into their organizations.
For me, this has meant sharing this approach with the students and athletes with whom i work, and with my colleagues and especially with folks i meet in places like this blog.
Practice: All the Time in the World
I've had a few folks ask me "so are you still doing that method?" The answer is yes. Indeed, as said, i'm a fan of the approach, in particular the exercises that are so related to particular circumstances. As folks who have ordered the SM and followed up with me will atest, if they have questions like "is there something i can listen to that might help with X" - a reply with "yes CD A Track B" comes back pretty quickly - normally cuz i've struggled with these things myself. Certain parts of the ipod's drive must be ground in by now.
A suggestion is that it really helps to make the course a priority for a weekend. Plan it as a retreat. I was luck: i got struck down by germs and could do nothing else. If i hadn't i'm not sure i would have had the results i did as quickly as i did in finding a path into this stuff. After that initial three day burst to go through everything, i spend the next couple months repeating areas at night or, as said, while doing intervals (or while on trains to meetings).
Indeed, the blend of instruction, discussion and practicum is very good: it makes picking what's best for the moment very straight forward and practical/practicable.
Most earth shattering take away:
What if what you're doing right now is exactly the right thing to be doing?
-Hale Dwoskin, Living Truth - the Sedona method
-Hale Dwoskin, Living Truth - the Sedona method
For me that one question has been pretty revolutionary and it came after i'd gone through the sedonam method disks what was likely a couple of times. I was still having some stuff up around judgements of myself not seeming to get certain things done that i "should" be doing (should quickly becomes a flag to investigate further).
If we allow ourselves to consider the possibility that what we are doing right now is exactly right, i have found anyway, that a whole lot more crap falls away, enabling even more possibilities and less stress.
Now we know from so much related work in health and phsiology that a steady diet of stress is a Bad Thing. It literally wears us away with oxidative stress, ie rust. Being stressed effects our sleep our diet how are bodies process sugar all sorts of stuff. So if there are approaches that help us let go of stress - even the imaginary stress of "should" then the release that occurs from this alone for our health is substantial.
Personally, i feel better - i feel that
- Greater ease, effeciveness and joy in daily activities
- An increase in positive feelings
- A decrease in negative feelings
- More love towards one's self and other
- Positive changes in behaviour and or attitude
- More open and effective communications
- Increased problem-solving ability
- more laughter
- greater openneness and flexibility
- Clearer reason and more natural intuitive knowing
- Being more relaxed and confident in action and at rest
- Accomplishments and completions
- New beginnings
- greater ease in aquiring new abilities or skills.
One more note on practice - it is a practice. Like anything else with our brains, i've found the SM is a kind of use it or lose it. While i'd become so familiar with the CD's i didn't feel i could listen to them again, after several weeks' pause, I've recently gone back to refreshing the concepts right from scratch, and it's been very good to do so. What triggered the need is feeling myself getting caught up in some shoulding and not quite feeling the positive feelings i had. So i want to perk that up a bit again. And it's working. It's good to go over the drills as a refressher - ah yes - this is the way of letting go here.
Bonus Bliss
Yes, i can honestly say that with some of the final exercises, along with another SM product called the Bliss Mini Retreat - i have felt that bliss experience that we hear about from letting go and getting to that higher place where everything is connected. It happened while waiting for a flight and listening to the follow along "allow yourself to..." guidance. It then happened listening again while getting a ride into a conference venue.
It's pretty cool. It's pretty joyful - and something to let go of as well, but in a good way. It's nice to know that without having to leave the world and study for a lifetime, one can with a bit of practice on these courses, hit the ipod and literally bliss out. It's quite the recharge.
Value for Money
SO, all in all, the Sedona Method is great value for money. Also the guarantee is 100% refund within 6 months if you want to send it back.
But that's just price. It's equivalent to a three day course in materials, but an n'th of the cost. It's structure is that of the best of breed three day course, and while they cannot say due to legalize that practicing the SM results in health benefits, i can say that in my own experience that its practical, pragmatic approach to looking at one's crap in a way to let go of it such that one can become a more functional, concurrently de-stressed, more joyful person, means that one has improved well-being.
Even for my grad students - students always being poor - this is excellent value for money - why? Stress and emotional turmoil is the lot of too many students trying to complete their degrees - especially advanced degrees. Anything that can legally help a person see more clearly, focus, get work done, is a good thing. Without this foundation, all the time management strategies in the world won't work: they have no stable surface on which to work.
Likewise for athletes: stress at the right moment has been said to be useful to achieve a result. In watching the best of the best athletes however, the ones who *seem* to be relaxed and open seem to perform with excellence. I'm thinking of for instance Usain Bolt's 100m sprint last year at the olympics. Or Roger Federer's and even Andy Roddick's open swings on the court of the Wimbleton final.
The SM seems to offer a variety of mental strategies to cut through the dross and get to the heart of what matters, and let that material sing. Healthy, wealthy, well.
Lighter, more joyful, more open, more flexible. Abundance.
In my experience, these are all good things, and the SM has proven a great accelerator to experience them.
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