Beatriz Nascimento, MA, OTR

What Exercise?

Here’s the dilemma.  No exercise — some muscles get chronically tight and sore, others are flabby.  All those years of driving down to the corner store and sitting on the couch watching TV will shorten your life.  The wrong exercise — you get months of back pain, a torn ligament in the knee, even a heart attack.  The right exercise — you look great, feel wonderful, and live a lot longer.  Your body is built for regular movement; the health of every system of your body depends on it. For elderly Americans, it’s critical; without an adequate exercise program, muscles and nerves in the legs die off in large numbers, you lose the ability to walk, and, when you’re wheelchair-bound, much of your ability to fight off pneumonias and other infections is lost.

For everyone, it’s important to get the right exercise dose.  Even professional bodybuilders can get it wrong — too much strengthening and not enough stretch results in muscles that are so tight that it’s painful to put on a T-shirt. Similarly, the yoga student who overstretches without adequate strengthening can ruin ligaments and bring on chronic muscle spasm as the body tries to compensate for pathological looseness.

For many healthy but sedentary people, it’s realistic to begin a well-thought-out program of stretching, weight-training and aerobic exercise at the Y; eventually they’ll be able to handle an occÿsional bout of weekend athletics without getting injured.

For some people, this will never be a possibility.  If your muscles are weak because of a neuromuscular disease or loss like cerebral palsy, stroke, or multiple sclerosis, and you force them to perform “like other people” or “like before,” beyond their capacity, you’ll only accelerate the breakdown of muscle fibers and nerves.  Your body will compensate for weakness in the arms or legs by overworking other areas, especially your shoulders, back, and hips.  As a result, you’ll increase muscle stiffness and pain, and, if you keep up this kind of exercise, your everyday movement patterns will become strained and unbalanced.   Even with relatively gentle programs like yoga or tai chi, I’ve seen outcomes ranging from disappointment to injury for people with chronic fatigue syndrome, fibromyalgia, and elderly people.

I can sympathize with the desire to “work out like everyone else,” in mainstream exercise programs.  I have muscular dystrophy.  For years, while I longed to look and move like normally healthy people, psychotherapists told me that I needed to accept my body — utterly useless advice.  I can tell you from personal experience that the only way to accept your body when you have a disability is to have a pleasant experience of it.  You stop comparing yourself with others when you find your body’s beauty and gracefulness, through exercises that are right for you. And you can get a lot stronger.

In my Self-Healing practice, I have a client with a mild case of multiple sclerosis.  She insisted on doing 10  epetitions every day of plie (knee bends) in each of the five classic ballet positions.  Because her legs weren’t strong enough, she tensed up her back, neck and shoulders.  It didn’t make her legs stronger, but it did make her walk even heavier, stiffer, and more energy-costly.  I gave her the following knee bend exercise, which not only strengthens major leg muscles but also relieves pain and tension in the back:

Leaning your back against a wall, with your legs straight, place two tennis balls between your back and the wall, in the small of your back. The balls should not press into bone; position them on the broad band of muscles next to and parallel with your spine, one on each side.  Press yourself against the wall hard enough to keep the balls in place, and slowly bend your knees.  The balls will roll upward toward your shoulders.  Then, as you straighten your knees, they’ll roll downward again.  Experiment with the starting position of the balls so that you get a nice massage of these back muscles, which are chronically tense in most people.  If, like my client, you have a movement impairment, start with shallow knee bends and increase their depth slowly.  You’ll build  strength and flexibility together in your legs.

This exercise is helping my client accept and enjoy her body.  Along with other exercises in her Self-Healing program, it make her everyday movements lighter, more graceful, and less effortful.  This is important; people with disabilities lose the ability to walk when their movements are so strained that it costs a lot less energy to use a wheelchair.  When you move out of relaxation rather than stress, in a balanced way, you can do a lot more with weak muscles than you ever thought possible.

As is usual in Self-Healing, this client’s program started with evaluation and massage.  I evaluated her lifestyle,  observed how she moves, and assessed her by touch as I massaged her.

When we have chronic stress, muscle tension, or depression, we need massage to prepare us for exercise.  Massage relaxes the mind, the nervous system, and the muscles, and releases toxins.  It creates more space in the body by stretching contracted musclõs.  If muscles, tendons, and ligaments are stiff, our range of movement will be limited, the forces around our joints will be unbalanced, and impact in exercise will not be uniformly absorbed — this is when we’re likely to twist an ankle or damage a knee.

Exercise is safest and most beneficial when it is a body/mind experience.  I prepare a client’s body for mindful exercise through a combination of massage, breathing, and passive, active, and visualized movement.  When you focus attention on movement and breath, you develop a subtle awareness of your body’s status right now  — where you’re holding tension, and movement and sensation are limited, and what is the next step for your body in terms of movement.

For a client of mine with chronic fatigue syndrome, her next step was to move each of her joints in gentle, slow circular movements, for a few minutes, as she breathed slowly and calmly, deeply paying attention to what she was doing, then resting.  She gets her exercise in brief, low-intensity doses that teach her how to move out of relaxation — a much better plan than using up the energy for an entire day in five minutes on the treadmill or a few biceps curls.  She’ll safely build endurance this way.

So what’s next?  You’ve gotten in touch with your body’s movement limitations and needs — remembering that limits are only temporary. You nurture your body with movement every day, exercising in a relaxed, mindful way.  Now it’s time to go beyond your comfort zone.  If we never push the body it will never get stronger.  The body likes to be challenged.  That explains part of the “runner’s high” and the satisfaction we feel after hiking for a day.

How do you know when you’re ready?  When the decision of exercising faster, longer, or trying something you have never done before, comes from a physical need to do it — from a restless sensation in the body rather than the competitive, over-achieving mind — go for it!