Clapham Osteopathy and Functional Movement

The Importance of Vitamin D

As we head into autumn with increasing concerns about a second wave, we believe that everyone should be getting a vitamin D test to ensure that you have sufficient levels for maximal health.  Even if you have spent time getting a tan over the summer, do not assume that your levels are high enough. Everyone’s ability to turn sunlight into active vitamin D is different, and this decreases as we get older. If your levels are low, you should consider supplementation to minimise your risk of severe COVID-19 symptoms this winter.  It is estimated that in excess of 20% of the UK population is deficient in vitamin D, with the elderly and BAME population being at higher risk. Also remember that the recommended levels are actually very conservative, only indicating the level needed to avoid deficiency disease, not what’s required for optimal health, making supplementation even more important for many of us. You can get tested at your GP or check your levels yourself with a home test kit from Monitor My Health, whose profits go to fund the NHS.

Even though the mainstream is focused on vaccination and pharmaceutical solutions to COVID-19, there is increasing evidence showing that vitamin D is vitally important both in the prevention of severe disease and in treatment in the hospital setting as it modulates the immune system.  A new piece of research from Spain followed the treatment of 76 patients who were hospitalised with COVID-19.  They were given the same standard of care, except 50 patients were also given calcifediol, a form of vitamin D3.  In this group, only one patient (2%) was admitted to the ICU and recovered, whereas of the 26 untreated, 13 (50%) needed transfer to the ICU where 2 died and 11 recovered. This result is statistically significant and hopefully will be replicated in future larger trials.

The following graph shows the severity of COVID-19 symptoms by vitamin D status, indicating that it is important for prevention as well as treatment.

Vitamin D chart

Vitamin D is actually misnamed as technically it is a hormone not a vitamin.  It is synthesised in the skin in response to ultraviolet light from the sun, and is then transported to the liver and kidneys where it is converted to an active hormone. There are receptors throughout the tissues of the body, where its functions include:

  • Modulating the function of the immune system, stimulating it to produce antibodies
  • Regulating and suppressing the cytokine inflammatory response. The ability to downregulate the inflammatory response is particularly important for COVID-19, as out of control inflammation (cytokine storm) is a primary cause of death
  • Essential for the proper absorption of calcium into bones therefore reducing fracture risk and improving bone health
  • Important for proper contraction and relaxation of muscles, so making us stronger
  • There are many vitamin D receptors in the lungs and so can reduce inflammation here, which is very important in all respiratory illnesses
  • Reducing the risk of  high blood pressure and cardiovascular disease
  • Helping to regulate kidney function
  • Protective of cognitive function. Research has shown that seniors with low vitamin D levels have an increased risk of dementia
  • Reducing the risk of depression and multiple sclerosis
  • There is even some research that says that it is necessary for leptin, the satiety hormone, to work well.  So low levels could leave you permanently hungry, making it much harder to lose weight.

As you can see, there are many reasons beyond COVID-19 to ensure that your vitamin D levels are optimal.  A final thought is that if you do decide that you need supplementation beyond extra sunlight, which is going to be hard to get in the UK as we head into the winter months, you should seriously consider adding vitamin K2 into the mix. D and K2 work together to ensure that calcium is deposited into bones rather than into the soft tissues and arteries,  thus improving bone density rather than increasing atherosclerosis.  Vitamin K2 can be obtained naturally in natto (a Japanese fermented bean product that many people find disgusting, although we quite like it), some hard cheeses, and liver, but most people are not eating enough of these to get sufficient amounts of this vitamin, making supplementation even more important. So get tested, get some sun and, if your levels aren’t up to snuff, then get some supplements.

 

Follow Your Nose

Breath book coverIf you’ve visited us for treatment or training or even just followed our newsletter/blog with any regularity, you’ll know that proper breathing is a huge focus for us here at Backs Etc. Quite simply, breathing retraining is a game-changer. So we were very excited when we heard about James Nestor’s new book, Breath: The New Science of a Lost Art. Being fans of his previous book Deep which centred around freediving, a book by Nestor focusing directly on the art of the breath sounded right up our alley. And, with one exception, it didn’t disappoint. Frustratingly, there was no mention of the role of breath in creating Intra-Abdominal Pressure, the foundation of core stability. But even with this omission, there is a wealth of great information, so definitely worth a read.

But this post isn’t just a book recommendation. Today we’d like to focus on one aspect of proper breathing technique that is discussed at great length in the book: nasal breathing.

If you’ve ever watched a baby breathing, you may have noticed that, barring any developmental issues or a cold, they will always be breathing in and out through their nose. This is instinctive and it is the way we are designed to breathe. Yet, so many of us seem to have lost this over the years, and the effects can actually be quite serious. Perhaps this is why the term “mouth breather” can be used as a pejorative, just as Mike does in Stranger Things.

Breath starts out with a bang. The first chapter is entitled The Worst Breathers in the Animal Kingdom, and you can probably guess who is being referred to. Spoiler alert: It’s us! If a vet or farmer come across an animal that is mouth breathing (except for a few that pant to reduce heat), that is a pretty good indication that the animal is sick, but humans mouth-breathe for years with no idea that something is wrong.

After learning about humanity’s poor breathing epidemic, Nestor and fellow pulmonaut (as those who have stumbled on the power of breathing are referred to) Anders Olsson embark on an experiment casting themselves as guinea pigs. For 10 days, the two men were forced to breathe solely through their mouths, even whilst eating, exercising and sleeping with earplugs wedged firmly in their noses. Phase 2 of the experiment had them repeat the exact same activities, but with nasal breathing as well as some specific breathing exercises. At the beginning, middle and end of the experiment, their blood gasses, inflammatory markers, hormone levels, sleep, pulmonary function, and more were thoroughly tested, and of course, they also documented how they felt throughout.

The results were pretty spectacular. With his nostrils blocked, Nestor’s snoring and sleep apnea events increased dramatically, his blood pressure spiked at an average of 13 points higher than usual, and indeed all of the markers tested indicated increased dysfunction, some quite seriously so, and these effects started almost immediately on around day 2 of the experiment. Anecdotally, though no less significant, he and Olsson felt simply awful, with Nestor describing the experience as being “trapped in some sad sitcom in which nobody laughs, a Groundhog Day of perpetual and unending misery”. Conversely, the 2nd phase of the experiment where the two men breathed exclusively through their noses, produced dramatic improvements in every marker tested, and consequently, they slept far better and felt energetic and mentally sharp.

So, why is nasal breathing so much better than mouth breathing, you may ask. The answers to this are so powerful and numerous that they could probably have their own book, but since you’ve stuck with us this long, we’ll give you a taste:

Nasal breathing produces nitric oxide. This is hugely important as this molecule plays an essential role in increasing circulation and delivering oxygen into cells. Immune function, weight, circulation, mood, and sexual function can all be heavily influenced by the amount of nitric oxide in the body. In fact, Viagra works by releasing nitric oxide into the bloodstream which opens the capillaries in the genitals and elsewhere. The effect of nitric oxide on the immune system is especially crucial during the pandemic we are currently experiencing, and some people theorise that proper breathing can make the difference between being mildly symptomatic and getting very sick if you are exposed to SARS COV-2. If you mouth-breathe you are completely missing out on the benefits of nitric oxide.

Nasal breathing filters the air. The nose is lined with cilia, tiny hairs that can trap potentially harmful particles which would otherwise enter the body. These cilia also help regulate the temperature of the air before so protecting the lungs, helping improve proper lung function. They also moisturise the air, which helps to reduce the risk of respiratory conditions. If you wake in the morning with a dry mouth that indicates that you have probably been mouth breathing during the night and so would benefit from taping your mouth at night as described in the book.

Nasal breathing can calm the mind. By stimulating parasympathetic (“rest and digest”) nerve receptors, nasal breathing can reduce anxiety and improve our mood. It’s interesting to note that each nostril works independently. The right nostril stimulates the sympathetic nervous system and the left activates the parasympathetic nervous system. If there is an imbalance, alternate nostril breathing, such as that practised in certain yoga techniques, can be helpful.

Nasal breathing can improve facial structure. Nasal breathing allows for your tongue to rest on the roof of your mouth resulting in the proper development of the jaw, sinuses and teeth.  This is particularly critical in children for proper facial development. The tongue-up position also acts as an anterior support for the head, without which there is an increased likelihood of neck pain, headaches and a forward head posture.

Mouth breathing is dysfunctional. Amongst other issues, mouth breathing can increase blood pressure, create sleep disorders (including snoring and sleep apnea), and cause dental health issues and facial deformities. It also allows unfiltered, dry air to be delivered to our lungs increasing the risk and severity of respiratory infections.

Mouth breathing can make us dumber. A Japanese study showed that rats who were forced to mouth-breathe developed fewer brain cells and took twice as long to make their way through a maze than those who nose-breathed. Studies on humans also showed mouth breathing to potentially increase the risk of ADHD.

The scientific evidence is overwhelmingly clear that breathing through the nose can greatly affect our health and wellbeing. We should be able to nose-breathe during the day and night and even during exercise, yet so many of us seem to have lost the ability to do so. The good news is that pretty much everybody can relearn to breathe the way we were born to. Even if your nose often feels blocked, you can still learn to breathe correctly.  Breathing retraining plays a big role in the treatment and training we provide at Backs Etc. and can be done in-person or remotely. For a brief primer, check out our video here, and If you are interested in working with us directly to learn to breathe properly, please follow your nose and get in touch.

Coronavirus and your immune system

coronavirus and masked womanFour weeks into lockdown and we are well into our new routine here in Clapham: daily meditation and exercise followed by video calls with patients, a daily walk, and more time for study, reading etc.  We are also preparing for the possibility that we will contract COVID-19 at some time over the next year. We are approaching this as though we were training for a race or other athletic endeavour. We are not hoping to get it. However, with the reality of a vaccine being at least 18 months away, it seems unlikely and undesirable, considering the effects on the population’s mental, financial health that we can all stay on strict lockdown until then.  We, therefore, want to spend this time preparing our immune systems to be in the best possible shape to mount an effective response to the virus.

Although the knowledge of this pathogen is evolving from day to day, we know that there is a vast difference in the effect it has, with most people getting mild symptoms easily treated at home, but a few suffering very badly and needing intensive medical support. Why is there this difference? The answer is multifactorial and may relate to the amount of the pathogen they were exposed to i.e. viral load, which may explain the number of medical staff treating COVID-19 patients without adequate PPE that have succumbed. But the other factor is the response of the infected person’s immune system, which has a genetic component but is also related to a person’s current state of health and metabolic function.  Almost everyone who is getting seriously ill is suffering from an underlying condition or conditions such as heart disease, diabetes or obesity. It is known that all of these have a lifestyle component and are hitting people at increasingly early ages.  Therefore, there is much we can do whilst in lockdown to improve our health and immune systems.

In short, the things that you can do to improve your immune system response are also things that will improve your metabolic health and resilience. So here are some ideas split into three groups: nutrition, exercise, and psychological. Now, none of us is perfect, and doing all these things all the time may be too much, so we believe in the 80:20 rule, especially in lockdown: try and do as much as you can (80%), but don’t beat yourself up too much when you trip up (20%).

Nutrition – immune health starts in the gut!

  1. If you are overweight or obese, this is the time to try and tackle this problem as it really does increase your risk of a poor outcome with COVID-19. This is often related to insulin resistance.  If you want help with diet or exercise, Jack has a wealth of experience.

  2. Even if you are of normal weight you need to think about your diet and try to eat as healthily as possible.  Much of the immune system is in the gut lining, so if you are constantly bombarding this with too much sugar, alcohol and processed food, this puts the system on alert, starting the chronic inflammation which is the underlying factor in most lifestyle diseases.  So do try to eat real and nutrient-dense food to get sufficient micronutrients for the normal physiological function of your body.  We focus on unprocessed meat (including organ meats) and fish, with plenty of vegetables and a moderate amount of fruit and fermented dairy.

  3. There is also some evidence that industrial vegetable oils drive inflammation, so another reason to avoid processed foods which are full of these. Cook with butter, olive oil, coconut oil or animal fat.

  4. Many of us now have more time under lockdown to get into the habit of cooking meals from scratch. If you do want a comforting sugary treat, make it yourself from real ingredients.

  5. It is also important to support your microbiome, so we make sure to eat fermented foods such as kombucha, kefir, and sauerkraut every day

  6. We have increased our use of supplements as an insurance policy, but supplementation is not a substitute for a nutrient-rich diet. We are currently using:

    1. Vitamin D

    2. Vitamin C

    3. Fermented cod liver oil

    4. Astragalus

    5. Turmeric

    6. Magnesium

    7. Zinc

  7. We also use intermittent fasting as this can boost immunity and enhance longevity via autophagy. We generally skip breakfast, resulting in a 12-16 hour intermittent fast, and since lockdown have added a weekly dinnertime to dinnertime (24 hour) fast.

  8. Don’t drink too much. Alcohol is not great for the immune system. Sometimes the reduction in stress from a glass of wine is more important, but don’t overdo it.

  9. Stop smoking – this shouldn’t need any explanation

Exercise 

Exercise has an effect on the immune system but it is a Goldilocks situation. Rather than HIIT or long runs, both of which can contribute to an inflammatory state that can suppress the immune system, focus on lower-intensity activities such as walking, mobility, breathwork, and bodyweight training.

Check out our new video where Jack puts Sue through a bodyweight training session, offering some ideas on how to improve your fitness without much space or proper gym equipment. Also don’t forget that Jack can help design you your own workout by video, or if pain is stopping you from exercising, both Sue and Joel are offering video calls to help you.

Psychological

Our mental state literally affects our physiology, and increased stress levels suppress our immune system, so we do need to try and keep fear under control at this difficult time:

  1. Breathing and or mindfulness. Check out the breathing video we featured in the last newsletter.  Diaphragmatic breathing can stimulate the spleen, the home of your immune cells.  It sits under the lower ribs on your left side so encouraging the movement here may improve its function.

  2. Limit consumption of news and social media. We do need to stay abreast of world developments, but ration it to maybe once a day, and try not to focus on the things that you can’t do anything about.  That fear and stress amp up your cortisol levels and suppress your immune system.

  3. Watch some comedy or put on some music and dance instead.

  4. If you are not in a vulnerable group, try not to obsess about contracting COVID-19, but do be concerned about not passing it on.

  5. Try some gratitude, even though the world is in a difficult situation, trying to focus on a few small good things can be really helpful for our state of mind, as without effort we do tend to focus on the negative.

  6. The Greek philosophy of stoicism, which advocates facing challenges with grace, humour and perspective may be of help.

  7. Maintain virtual contact with friends and family. We’ve been arranging a few ‘quarantini’ dates (remember the 80:20 rule for drinks) with friends near and far.

  8. Cold showers can give your immune system a boost, as well as wake you up!

  9. Sufficient sleep is a huge factor in immune function.  Some people find that lockdown is giving them the chance to sleep more as they are no longer ruled by the tyranny of the alarm and the commute, but for others, anxiety levels may be increased and make sleep harder.  It’s important to follow good sleep hygiene rules, and try to avoid caffeine and alcohol close to bedtime, and if you still need a little assistance try herbal remedies such as valerian, reishi mushrooms, magnesium or 5-HTP rather than sleeping pills, which don’t provide true restorative sleep and may leave you feeling knocked out the next day.

mona lisa with a mask

Kathy Dooley: Restoring Authentic Breathing and Core Control

This article was originally published By On Target Publications, and can be found here.

I am very proud to call myself a chiropractic rehabilitative specialist. Rehabilitation requires rebuilding patients from the ground up, starting at the reflexive stability with which we were genetically gifted.

However, my patients are shocked on the first visit, when I point out their suboptimal breathing patterns and lack of core control.

I always get the same retorts: “but I breathe all day. How can I not be good at it?”kathy-dooley-breathing-crunch

“I do tons of crunches and ab work how can my core not be strong?”

It’s hard to admit that we exist in a sub-optimal state of movement. But many of us do.

It’s important to understand that we did not start off that way.

We are the best movers we’ve ever been within the first 4-13 months of our lives. This is when our nervous system didn’t mimic, nor try to derive compensations, for movement. The reflexive stability to earn movement was passed down through our DNA, and at this early stage, our bodies knew better than to interrupt perfection. So, the baby struggles and fails, on repeat, until he figures out the stable way to move.

The longer we live, the stronger our cognition develops. We mimic the behaviors of those in our environment, as more opportunities arise for our innate perfection to be interrupted. And since we amazing humans don’t prefer failure, we derive compensations around our failures.

Make no mistake. Aches and pains are not failures. They are attempts to succeed in the face of failure. This is why aches and pains must be approached as simple compensations, veering away from our innately perfect stability.

In order to tap back into that inborn perfection, one has to regress to achieve the dynamic stability earned at 3-4 months of age. This includes the baby’s boring days of learning how to build trunk stability in positions on the belly, prone, and on the back, supine.

kathy-dooley-breathing-baby-prone-supine

I have the honor and pleasure of co-owning a mid-town Manhattan clinic and gym, Catalyst SPORT, where our utmost principle is: never rob trunk stability to gain fitness. In the eyes of our clinicians and trainers, nothing is more crucial than the maintenance of trunk stability. Trunk stability is the stable platform for all human movement around its center of mass: the lumbosacral spine.

But, trunk stability is not reborn through traditional, widely used core exercises crunches or sit ups. Watch a baby. You’ll never see her do a crunch, especially on repeat for 100 reps.

Babies build trunk stability through breathing.

At 3-4 months, the baby does the boring and endless task of earning trunk stability through the proper building of intra-abdominal pressure. All day, every day, they spend months coordinating the abdominal muscles to build trunk stability around the lumbar spine, in order to support the center of mass relative to the ground.

Think for a second about that. Unless the nervous system is interrupted, the baby refuses to move on an unstable platform. So, he works on trunk stability for thousands of repetitions per day. He knows that ambulation on an unstable platform will only get him hurt.

He doesn’t think about it. He doesn’t walk around his road blocks. He earns every ounce of his strength. When was the last time you did tens of thousands of reps per day, for months straight . . . of anything?

Most likely it was in your first year of development.

At Catalyst SPORT, we start all workouts with breathing correctives, either in supine or prone positions. We know that our clients initially used breathing for core stability at the strongest time in their development. Thus, we use proper breathing to build a stable foundation upon which to build fitness and rehabilitation.

Clients may not be compliant with breathing drills. In that case, it is necessary to remind them that they are amazing humans, who create compensations around potential failures. The auto-pilot breathing patterns they’ve developed may not be the optimal ones they utilized as babies.

But, in infancy, they develop the fastest and with the maximum amount of stability. Thus, regressing to the way the baby breathes can tap us into the trunk stability we earned when we were at our peak of development.

Prone breathing, often deemed “crocodile breathing,” is utilized to tap into posterior abdominal expansion. A stretch sensation is often felt and seen around the lumbar spine, which clients report a feeling of relaxation and stability.

This can be progressed into a prone-propped breathing, as seen in the baby at 3 months. Often deemed “tummy time,” this breathing and resting position is crucial for developing proper spinal extension patterning on breathing. This transfers into proper extensibility and load-sharing with spinal extension in movement.

Also at 3 months, the baby breathes in the supine position, developing proper coordination of crucial inhalation muscles like the thoracic diaphragm and exhalation muscles like the transversus abdominis and abdominal obliques. The four sagittal plane spinal curves are maintained, while one expands the abdomen into a 360-degree push-out on inhalation. Exhalation in performed in a controlled release of air, much like a tire releases air from its valve. This creates core stability around the lumbar spine to permit limb ambulation on a stable platform.

This position is often called “supine 90/90,” with the knees and hips flexed at 90 degrees. The heels can rest on a ball or chair, but ideally, they would suspend in the air, as seen below.

Prone and supine breathing are simple. But, they are not easy positions for most people, particularly those suffering from pain in the spine or limbs.

Typical rehabilitative and personal training strategies may be tempted to focus more on what hurts or what is missing. But without trunk stability, the entire platform wobbles around the center of mass. If breathing is what we used as a baby to stabilize the platform than it must be our primary focus of all corrective and performances exercises.

On Movement

“As kids, we move a lot without thinking, but as grown-ups, we think too much without moving.”

This quote comes Erwan Le Corre the founder of MovNat.  We all know that kids move: They play, they run, they jump, they crawl, they spin, they climb. They literally cannot stop moving until we manage to grind it out of them. This is a disaster.

Meanwhile, adults do the opposite. We sit around all the time. We go to the office and plunk down on our butts. We barely find the time to go to a gym in order to walk on a glorified hamster wheel and lift some heavy pieces of metal once or twice.

But we adults also simply spend too much time in our heads thinking and planning and never acting. And in doing so—in thinking without acting—we’re actually less cerebral. The person who thinks and acts is more in tune with their brain than the person who thinks and over-thinks and ruminates and over-ruminates.

Ours is a neuromuscular system. Brain and body are one. You can’t separate them. Can’t do it physically, can’t do it metaphorically. They are one.

Because “moving” isn’t just about exercise. It’s also essential for cognitive function and mood.  In evolutionary terms, the initial function of the brain was to allow creatures to move – thinking was the icing on the cake.  There is a type of sea squirt that, in adolescent form, pulses through the ocean looking for the perfect rock to settle on for the rest of its life.  Once found, it then autodigests its brain as it is no longer necessary, which seems to say something about the hazards of being a couch potato.

We all need to move often and well so that these patterns become ingrained in our nervous system, and that we do them intuitively. We should go for long walks as a habit. We should take the stairs rather than the elevator, and stand, rather than sit, on the tube not as a conscious decision but as an instinct. It is important to make an effort to build this structure into our society, especially as labour-saving devices are decreasing the absolute need to incorporate movement into our lives.  Therefore, it needs to be a conscious choice.

Exercise aside, there are loads of ways of incorporating more movement into our daily lives. Here are just a few:

  • Standing on one foot whilst brushing teeth. Also, try brushing with your non-dominant hand.
  • Stand on one leg to put on your socks.
  • Squat or half-kneel whilst doing things. Even sitting on the floor is better than folding ourselves into a chair, as we will naturally shift around a lot into different positions.
  • Practice different ways of standing up from lying down or seated.
  • Pick up things off the floor with your toes.
  • Do calf raises when washing dishes or other chores.
  • Get off the bus or train one stop early and walk the rest of the way.
  • Take the stairs or at least walk up the escalator.
  • If you arrive early to an appointment, walk around the block instead of sitting down and waiting.

Explosion in the Vegetable Aisle – In Praise of the Big Ass Salad

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Real men don’t eat salad. But if they did, they’d eat BIG ASS salads. Side salads? Pfft. Let’s face it, when eating out, if you get a choice of sides, say fries or salad, are you really going to pick the salad? No siree, fries all the way. And for a starter, who orders a salad? Okay, I admit, I’m a bit of a sucker for anything with cheese in it, so a beetroot and goat cheese salad or mozzarella, basil and tomato, yeah I could do that. But a green salad? Highly unlikely.

Given these views, you might be surprised to learn that I’ve eaten pretty much the same thing every day for the past few years that I’ve lunched at home. And being that, as of this writing,  I’ve been working from home for quite a long time, that is a lot of lunches! Could it be? Well, given the title of this piece, I think it’s pretty obvious where I’m going with this. Yes folks, my daily lunch is none other than a salad. But let’s be clear, these are big ass salads that I’m talking here. Perhaps even BIG ASS salads, but for the sake of not having to hit the caps lock key any more than I have to, let’s just leave that as ‘big ass’, shall we?

Part of the reason for this (some might say) extreme salad consumption is that I went low carb towards the end of 2015, so I needed an alternative to the typical sandwich ritual that so many of us share. Then I found out I was sensitive (intolerant? foodist, even?) to gluten, furthering my need for a sarnie substitute. Enter the big ass salad!

One of the biggest knocks on salads is that they’re not filling. Surely you’ll be hungry an hour after eating one, right? Well, maybe, but honestly, I’m pretty much hungry an hour after I eat most anything. There are a few exceptions to this rule, such as a massive steak and chips (especially in Argentina!), an entire New York pizza pie, and anything and everything at Thanksgiving.  The important thing to note is that a big ass salad, with the proper ingredients, can be filling, satisfying, and – let us not forget – healthy.

For me, the keys to a successful big salad are the two Vs: volume and variety. This is a big ass salad after all – emphasis on the big – so naturally, it needs volume. I like my salads to go to 11, piled high on the plate and spilling over the edges. Remember, this thing’s gotta fill you up!

The old adage ‘variety is the spice of life’ has never been more apt. For me, a successful big salad needs to have at least 10 ingredients. Why 10? I suppose keeping with the Spinal Tap reference, I could say 11, but that’s just getting a bit silly, so I’m sticking with 10.

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First, there are the staple veggies:

  • leaves – Whatever you like. Lettuce, rocket/arugula, baby spinach, watercress, etc. Whatever you prefer. I often keep multiple types on hand, and use a mix.
  • tomatoes – I prefer cherry, baby plum or grape, as they’re sweeter and tend to have more flavour than the big ones, particularly the supermarket variety.
  • carrots – I usually grate one in as it’s easier to pick the pieces up with a fork unless you can slice them super thin.
  • beetroot – I always have some of the packaged cooked ones around, as they’re really simple to use. Forget about cooking them from scratch unless you’ve got some time, as they take forever.
  • cucumber – Sue hates these, so I only use them if the salad’s just for me.
  • avocado – Gotta be ripe! Nothing worse than a rock hard avo. We always have a few in different stages of ripeness so there’s usually a ripe one on hand when it’s needed.
  • spring onions – Get a little zing with some spring. Scallions to us Yanks.
  • peppers – Red, yellow and orange are sweeter than green, so my preference.
  • radishes – These are great to add a little peppery crunch. They seem to keep a nice long time in the fridge too.

Then there’s the protein. This is key for a big ass salad, otherwise, let’s be honest, it’s just rabbit food. Depending on your tastes, you can go loads of different ways with this. Some ideas are:

  • tinned fish – I like tuna, but sardines, mackerel, etc. also work. Tinned salmon is usually the wild kind, so that’s a good option as well.  In fact, any tinned seafood or fish can be used.
  • smoked salmon – This always feels very civilised! The nice thing about the thinly sliced packages is that you can keep emergency supplies in the freezer, and thaw them out in a couple of minutes by sitting them in hot water.
  • fresh meat or fish – Fry up a thin steak or nice piece of fish, slice it up, and you’re good to go.
  • leftover meat – Yesterday’s roast chicken, beef or lamb, shredded or cubed, works a treat.
  • bacon – Yeah baby! The meat product you hate to love, but you know you do! (sorry vegetarians, more for us) Get good quality bacon. I go for cuts without sugar whenever I can.
  • hard-boiled eggs – A great option for vegetarians and carnivores alike. So much nutrition packed into these things. We always have a few boiled eggs at the ready in the fridge, but they’re quick to make if you haven’t planned in advance. Often I’ll add an egg in addition to another protein.
  • cheese – Another vegetarian staple. I don’t know how you vegans live without it! Cube up some cheddar, crumble some feta, shave some parmesan, take your pick. I’ve never met a cheese I didn’t like. (Though I confess that I’ve never tried Casu Marzu  – Sardinian maggot cheese – and don’t know if I would.)

The fun stuff, the extras that give your big salad extra flavour and/or texture

  • nuts – The captains of crunch! I find walnuts tend to go particularly well, but use whatever you like.
  • sun-dried tomatoes – Tomatoes taken to a whole new level. These are so ridiculously flavourful, just a few chopped up will go a long way.
  • olives – Aaaah, concentrated salty goodness!
  • beans – Chickpeas, lentils, red or black beans can add body and flavour (not to mention gas).

The good (for you), the bad and the ugly. These are optional ingredients that I tend to primarily add for their nutritional benefit. In actuality, though, they can taste pretty nice.

  • seaweed – A bit of an acquired taste, but can add a good touch of seafoody saltiness. There are a number of different types you can choose from such as dulse, wakame and sea spaghetti. If it’s dried, make sure to soak it first to soften it up.
  • sprouts – These also come in a variety of types: alfalfa, lentil, even quinoa and broccoli. I like to add a handful of these, as they’re really nutritious.
  • sauerkraut – I know this sounds weird, but I actually make my own kraut at home, as the fresh stuff (not the kind you buy in the supermarket) is a natural probiotic, so good for your gut!
  • Seeds – Some of these little guys, particularly pumpkin, flax, chia and hemp, are high in Omega 3s, as well as adding a bit of crunch.

Finally, the dressing. An absolute essential, a good dressing ties the whole salad together without overpowering it. My golden rule with dressing is NO BOTTLES! Store-bought dressing is nearly always filled with sugar, industrial seed oils, and other crap you neither want nor need. And it’s bloody easy to make your own! I tend to go for a simple oil and vinegar concoction, with a 2:1 ratio of oil to vinegar. I use extra virgin olive oil with sherry, balsamic or red wine vinegar, depending on my mood. Sometimes I’ll use lemon juice in place of the vinegar, which works particularly nice with fish and seafood salads. You can easily play around with dressings, adding other ingredients such as fresh herbs (especially basil!) mustard, soy sauce, a bit of mayonnaise or cream for creaminess, etc. Oh, and don’t forget the salt and pepper or even the coolest salad could wind up bland.

When preparing the salad, I like to chop or grate the ingredients up quite fine, adding them to a big bowl as I go. Then I pour in the dressing, toss it all up, and scoop it onto a plate. A big plate. And there you have it, the big ass salad: a tasty, filling and healthful meal that just happens to look like an explosion in the vegetable aisle. Enjoy!

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Getting up in Asia

Sue and I have recently returned from a 5 week trip in East Asia. The primary focus of the trip was assisting the amazing Immaculate Dissection teaching team in Tokyo and Taipei. For avid travellers such as ourselves, however, flying that vast distance without taking the opportunity to sample more of the region’s wonders would seem like madness. And so we added a week in South Korea, another one (hiking) in Hokkaido and a few days exploring Osaka. I won’t spend any more time on the holiday-making part of the trip as that would require an entire lengthy post to itself, except just to say that we had a fantastic time!

If you are a health, fitness or wellness professional, you should really check out an Immaculate Dissection seminar. These series of 2 day seminars bring gross anatomy to life through unique body painting whilst exploring powerful assessment techniques and corrective exercise. You won’t believe how much knowledge can be packed into 2 days!

In addition to anatomy, palpation and muscle testing, every ID seminar focuses on a few key exercises. The primary exercise ‘dissected’ in ID II: Lower Extremity Concepts is the get-up, both the well-known Turkish get-up and a variation called the Czech get-up that mimics an infant’s developmental progression. Like so many in the health and fitness world, we love these exercises! There’s a good reason why, if only allowed to choose one exercise, many would choose the get-up. In fact, here are 20 reasons:

  1. Promotes total body stability in all 3 planes of motion

  2. Trains the ability to get down to and up from the floor with ease, important for health and often lost in later life

  3. Trains the ability to move the upper body from the core and not the neck

  4. Promotes cross lateralization (getting right brain to work with left side)

  5. Takes your body through all the phases of gait so a great diagnostic, especially for runners

  6. Ties the right arm to the left leg, and left arm to the right leg

  7. Gets the upper and lower extremities working reciprocally

  8. Promotes reflexive stability of the trunk and extremities

  9. Stimulates the vestibular system, which contributes to balance

  10. Stimulates the visual system, which contributes to balance

  11. Stimulates the proprioception system, which contributes to balance

  12. Develops a front/back weight shift

  13. Develops upper body strength, trunk strength, and hip strength

  14. Closed and open chain shoulder stability

  15. Thoracic extension and rotation

  16. The ability to perform a good get up on each side should be a prerequisite for bilateral loading exercises such as a deadlift or squat

  17. Stability in two different leg patterns – lunge stance and squat stance

  18. Single leg hip stability during the half kneel and lunge phases

  19. A great warm up and self-assessment tool – try performing a controlled get-up on either side to check how your whole body is feeling before you train

  20. So easy to perform, even your dog can do it

Okay, you’ve probably guessed that number 20 is a big old fib. But, to be honest, I could probably add a few more to this list without being too repetitive. In actuality, get-ups are a little complicated, especially at first. But part of the reason for this is also one of the most significant benefits of the exercise: that it isn’t just one single movement pattern, rather, it’s an impressive combination of sequencing stability and mobility throughout all segments of the body. Each component of the get-up is an exercise in its own right, and the transitions between components are integral and challenges in themselves. Basically, there’s a lot of exercise bang for your buck!

Sue and Jack in phase 1 of the TGUBut with these rewards comes a risk. In this case, it’s the high frequency of points in the routine where faulty movement patterns or lack of core stability can present a real problem. Of course, no exercise should be performed with bad mechanics, but one with as many steps as the get-up comes with that many more chances to do something wrong. This is why it’s so important to break the exercise down and practice each section of it until the full flow can be performed correctly. We often give clients and patients the first phase of the get-up by itself as it’s a great core exercise and, if done well, can help correct many neck and shoulder problems. However, if done badly using the neck or momentum to propel the body upwards, it can make upper body issues worse.

In summary, if you’re not doing this exercise, you should be. And if you don’t know how to, or are feeling a little shaky about your form, we’d be happy to show you. Just book in a session at Backs Etc. and you’ll soon be gettin’ down with the get-up!

Anatomy of Core Stability

An excellent video visualising the anatomy of core stability and how to establish that stability through uniform activation of all the muscles that make up the core. A very relevant video as core work is one of our staples at Backs Etc.