Transforming your body is not as hard as many think it is; at least from the standpoint of figuring out what needs to be done to make the transformation. Does it take a lot of work? Yes. Does it take discipline? Yes. But is it hard to figure out how to do it? Without professional help, it can be because of all of the misinformation out there. With the right help, its as easy as following the gameplan that is put in front of you.

Strength training and conditioning with a properly designed, balanced out program that is intense enough to give your body the stimulus it needs to change, along with sound nutrition to help facilitate the changes that your training wants your body to make is exactly what is needed. If you have it all in front of you, all you need to do is put the work in and follow through. If you had this kind of guidance and help, could you make some amazing changes to your body, mind and life? What if you had the chance to win $1000 while doing it?

Well, this summer you can have this chance and you can have the guidance you need to transform your body and life. Research is clear: when you make positive changes in your body and you get stronger, leaner or more muscular, and get rid of aches and pains, it has positive effects on every other aspect of your life: Your confidence, your relationships, your sex drive, your work performance and your daily motivation to live life to the fullest.

So if you've been desiring to make a change in your body and your life, this is the perfect time to do it. Beginning in June, our 2013 Summer Transformation Contest will begin. With a grand prize of $1000, a second prize of a free month of training and a third prize of 2 free manual therapy treatments, you will have more motivation than ever. While these prizes are all great, the real grand prize will be a new and improved you along with a more positive and more productive life. So contact us today and come do it!  Don't believe its possible? You could make a transformation like this!  And this did not come with the added motivation of a $1000 prize!  Check out some others on our testimonials page and search our blog for even more! Take the jump and change your life!

Single leg stability and control, the ability to resist pelvic and rib rotation and strong and solid hip flexion are 3 very important components of an effective runner. They are also 3 very commonly missed components when it comes to a strength program for runners. Here are a couple of great exercises you can throw in to help your running performance.

2 to 3 sets of 8-15 reps towards the end of a workout work good for these depending on what you are trying to do.
Maintain good shoulder posture, stay tall and keep the down hip extended as you flex the working hip. Control the lowering. The angle and range of motion can be changed to be more specific for a sprinter versus a marathon runner, etc. with a sprinter having a much higher degree of flexion than a distance runner. 

2-3 sets of 5-8 reps towards the end of a workout work well with these. Grip the floor with your foot/pull your arch up, get tall, hold the handle straight in front of you for a 3-5 count and repeat. Be sure to get a good breath in through the nose before pushing out to get good stability from the diaphragm. Exhale through the mouth between reps.  Everything from the shoulders and ribs down to the foot should engage to help keep you stable.  These also work great to clean up any difference in abilities side to side. If you haven't done double leg, half kneeling or tall kneeling holds, definitely do them first and work your way up.

These exercises actually work well for many sports, since most sports involve running and single leg components.

    Once upon a time, if you would've told me I'd be writing about fingers, forearms and elbows instead of how to kill superhuman deadlifts and squats, I might not have believed you. However, as the waves glide in and suns set, you see hundreds of people, learn and expand your professional experience and things come about that you absolutely have to get better with. So, while I started out years ago worried about nothing else other than getting strong and packing on muscle, I have evolved and gotten into the world of soft tissue therapy, cumulative injury disorders and corrective exercise. Thus, I am now writing an article about the sexiest topic known to the fitness industry, achieving harmony among the forearm and finger muscles and keeping elbow pain away from the crowd. Ironically, the things we are about to discuss can also help build beasts and better performance. So moral of the paragraph, read the rest of the article and learn about making your finger muscles really really sexy. (or something like that).




    Many people have issues with elbow pain. These issues can usually be divided into two different categories: medial elbow pain and lateral elbow pain. Medial elbow pain is commonly referred to as “golfer's elbow” or medial epicondylitis. Lateral is commonly referred to as “tennis elbow” or lateral epicondylitis. Pain can stem from multiple causes: repetitive motion injury, overuse, misuse, compensation patterns, imbalances, etc. Issues might be present because of acute injury to the site. If you play a round of golf and strain a local muscle or sprain a ligament nearby, you will undoubtedly have pain. Issues might be present if there is something faulty somewhere else. For example, if your thoracic spine does not move well, you can easily put more stress through the elbow with many activities. Bottom line, there are many possibilities that could be hanging around. For the purposes of this article, I am going to discuss specific muscle imbalances in the hands and forearms themselves that can cause issues with elbow pain, specifically medial elbow pain.




    To fully grasp the information we are about to go through, we must first look at some basic anatomy. In a nutshell, we have muscles on one side of the forearm that flex the wrist and/or fingers and we have muscles on the other side that extend the wrist and fingers. We also have muscles that pronate and supinate our hand and arm (turn the hand down or up by rotating the radius and ulna around each other). The muscles that extend attach to the lateral epicondyle (that bone you feel on the outside of your elbow) and those that flex attach to the medial epicondyle (that bone you feel on the inside of your elbow). Some major extensors include the extensor carpi ulnaris and radialis and the extensor digitorum muscles. Major flexors include flexor carpi ulnaris and radialis, flexor digitorum muscles, and palmaris longus. These muscles run from the inner or outer elbow and run down to attach to various places along the wrist and hand (we won't worry about details here). If you look at the top of your hand or at the bottom of your wrist, you will see tendons of these various muscles popping out and can feel them move when you move your fingers and wrist around. If you want to get more in depth, we could also look at specific muscles that control thumb motions (pollicus muscles).  For the purposes of this article, we will worry about these main structures already mentioned. 

Now, you can develop problems with either group of muscles. That being said, in my personal practice and experience, I tend to see tons of people who have issues with pain near their medial epicondyle (inside of their forearm). I very commonly run into some wicked adhesions (knotted up muscle tissue) in the flexor carpi ulnaris that tug and pull on that inner elbow with many movements. The pronator teres is another muscle in the upper forearm that tends to get pretty bad as many human activities involve turning the hand/arm over with pronation. This article is going to focus on taking care of this very common issue.




As humans, most activities we do involve flexing our fingers and sometimes wrists. Think about it; we grab things, pick things up, squeeze things, walk with things, etc. Its just what we do. Personally, I lift heavy weights and do manual therapy on people so I use mine tons. I have a client who is getting ready for his first ironman. He kept having recurring pain right at that medial elbow site. We released the muscles around it (flexor carpi ulnaris, pronator teres, etc.) multiple times and it kept coming back. Well when pain continues to return, something is missing from the equation. So think about the VERY LONG duration activities that he is doing, specifically swimming and biking. With swimming, the way he comes through and turns his arm and hand over with his stroke is very taxing to all of the muscles of this region. With biking, he basically has constant tension there as he grips the handlebars for long periods of time. So obviously, these activities are contributing to the problem. However, while we could try to modify technique, the activities are not going to stop. So, we then need to start thinking about antagonistic relationships. Just like we want to balance out pushing and pulling muscles in the shoulder girdle and balance out squatting and hip hinging patterns in the lower extremities, we also need to look at balancing the extensors and flexors of the forearm and fingers. I decided to experiment. Funny story here.

So when I was 15, I bought a “forearm blaster” from Wal-Mart and used to do 100-200 reps each way 4-5 nights a week to add some size to my forearms. Yes it worked pretty well, as funny as it is. Well, I happen to still have this nifty little tool. So I started having my client perform 3 sets of 10-15 reps of wrist extensions both days that he came in to train. There are plenty of ways to do this exercise without a “forearm blaster,” such as using a small bar, a kettlebell, cable, etc. They're just not as cool :) Interestingly enough, this exercise introduction along with some frequent active release treatments, started to make the pain subside. However, it still was not perfect. Being the obsessive perfectionist of training that I am, this frustrated me. Sooooo, I went back to the thinking box. Wrist extensors and flexors are on their way to balancing out. What about the finger extensors and flexors? Now, I'm not going to lie; as decent as I am with anatomy and balanced out training, I had never worked my finger extensors directly with resistance in my life. I hopped online, found some ironmind resistance bands for the fingers and got to work. We have now introduced a few sets of finger extensions to the program and his pain is pretty much gone. He now has a counterpull to the dominant flexor tension that his body has been used to.




Many people go on for much too long with chronic pain at this site. Soft tissue work works great to free the tissue up but you need to fix the underlying problem to keep pain at bay; and if you haven't read my article “Got CID?,” I suggest that you do to learn more about cumulative injury disorders and how these adhesions and pain come about. Although this is not a commonly discussed topic in most fitness and strength and conditioning circles, it is pretty important. Not only can this help with pain syndromes, but it also will help grip strength and wrist control, which will help with many activities, from bench press and deadlift to grappling and swinging a golf club.



So, whether  you have pain near your medial elbow, just want to increase your grip strength and wrist control, or (the most obvious reason) develop sexy finger and forearm muscles for the beach this summer, give these exercises a shot. Perform 2-3 sets of 10-15 reps a few days a week. As I mentioned above, issues here can also stem from compensations such as limited t-spine mobility so be sure to address any other issues that are in the picture.

Here is a copy of a the first part of a research paper that I did a couple years back for massage therapy school.  I did research on pain in the posterior shoulder girdle and neck.  I did this paper here along with a hands on case study.  While its a little dryer than most of my stuff, since it was a research paper vs an article, its still a decent read. Give it a read!!
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Pain in the posterior shoulder girdle (I’m going to include upper back and posterior neck together) is a very common issue with many people who complain of pain. Unfortunately, many people seem to believe that the pain is just magically there, when in reality, there is an underlying cause and reason for the issues that an individual has. Specific muscles that are stiff or short, specific muscles that are lengthened or inhibited, faulty movement patterns and postural issues are all commonly significant causes of pain, especially in this region. Massage therapy can be a great tool in treating someone with this condition. In a 2003 study in the research journal Spine, a national survey on the most successful treatments used for back and neck pain was conducted. Massage therapy was one of the top 3 most effective studies. As a matter of fact, nearly one third of all complimentary provider visits were for neck and back pain in the year studied.

I am first and foremost a strength and conditioning specialist. Through my many observations working with a multitude of varying clients, a very common trend seems to be hyperkyphotic shoulders (or at least shoulders that are somewhat more kyphotic than normal) and weak upper back musculature with over lengthened tissue.   This over lengthened tissue develops poor quality and strains. In our society today, many people sit for a ridiculous amount of time throughout the day, leading to rounded shoulders, stiff hip flexors and a weak and lengthened posterior chain.

In “Muscles: Testing and Function with Posture and Pain,” Kendall and others discuss painful posterior neck muscles in great detail. “The compensatory head position associated with a slumped, round upper back results in extension of the cervical spine.” “The faulty mechanics associated with this condition chiefly consist of undue compression posterior on the articulating facets and posterior surfaces of the bodies of the vertebrae, stretch weakness of the anterior vertebral neck flexors, and tightness of the neck extensors, including the upper trapezius, splenius capitis and semispinalis capitis.” (Kendall, 2005, P.159) With the body’s inherited ability to try to maintain equilibrium, the kyphotic shoulders cause extension at the next joint up. This combination leads to neck pain, shoulder pain and often times headaches.

On top of the tissue creep and adaptations that take place from all of the time sitting with poor posture, many of the same people perform workouts that add fuel to the fire. A disproportionate number of movements that train protraction and internal rotation of the shoulder joint in comparison to the number of movements that train retraction and external rotation of the shoulder joint makes issues worse; as well as useless and harmful exercises such as crunches, which depress the rib cage. With the adaptations that people have developed, a combination of the appropriate corrective exercises and soft tissue work is very necessary. While one or the other may help to a certain extent, it is the combination of the two that is amazingly effective. What we also tend to see a lot is hyperkyphosis coupled with forward head carriage, which features overlengthened lower cervical muscles (splenii, erectors,etc.) and strained upper cervical muscles (suboccipitals).  The lower muscles  (C3 on down) help extend the head the neck while the upper (C1-C2) rock and tilt the head on top of the neck.  They have separate functions for many activities. Weak deep neck flexors allow this situation to remain.  The lines of tissue up here are all directly connected with deeper lines through rest of the trunk and body, so when we analyze and coach full body movements, we need to look at head and neck alighment as well.  This is often forgotten. 

In Diagnosis and Treatment of Movement Impairment Syndromes, Shirley Sahrmann gets very in depth with specific conditions that can cause neck and upper shoulder pain. Two “syndromes” that are discussed are scapular downward rotation syndrome and scapular depression syndrome. In these conditions, muscle imbalances around the area lead to impaired scapular resting position and motion. One common imbalance is weakness in the lower trapezius and serratus anterior with an excessive pull by the upper trapezius, levator scapulae and weight of the upper extremity. This creates a downward or asymmetric pull on the cervical vertebrae and in turn, neck pain. With the lower traps and serratus not doing their job in assisting with upward rotation of the scap, upward rotation is not fully achieved with shoulder abduction and flexion, leading to improper movement and pain. This also leads to a scapular resting position that is rotated downward excessively, causing specific strains throughout the day, even at rest. This is just the tip of the iceberg. Issues such as this can lead to a host of other problems around the area as well, including acromioclavicular joint pain, humeral instabilities, sternoclavicular joint pain, humeral subluxation and thoracic outlet syndrome. (Sahrmann, 2002, p. 217-224)




There can be a combination of issues, syndromes and imbalances. Ultimately, each individual must be assessed in order to determine what needs lengthening and what needs strengthening. While one individual may have a weak upper AND lower trapezius with over dominant, short rhomboids and levator, another person may have an over dominant upper trapezius, weak lower trapezius AND weak rhomboids. The first individual would need massage work done on their rhomboids and levator and strength work done on their upper and lower traps with real specific exercises. The second person would need lower trap and rhomboid strengthening along with tissue work on their upper traps and probably pecs, lats, etc. It all comes down to the individual at hand. (And of course this all then needs to be taken into account with full body movement patterns)




Another very common malfunction that leads to issues with pain in these areas is faulty breathing mechanics. The diaphragm should be playing a large role in breathing; however, many people have diaphragms that are not doing their job effectively which contributes to poor breathing mechanics and places the burden on other muscles. The problem is that these other muscles that now have to assist with breathing (more than normal) because of the poorly used diaphragm already have big time jobs that they are responsible for. Now they become overused and stressed because of the extra role they must now play. “Inefficient or inappropriate breathing patterns can lead to dysfunction, both structurally and physiologically.” (Rattray, 2000, p. 33)

In Clinical Massage Therapy, Rattray discusses two inefficient breathing patterns. Apical breathing occurs when someone mainly uses the upper chest to breathe. Their lateral ribs move a little and there is not much movement from the abdomen at all. The scalene, upper traps and levator scapulae are overactive and strain as the ribs raise during this faulty breathing pattern. (Note: We do want apical expansion,just not elevation) Paradoxical breathing occurs when someone’s abdomen doesn’t rise as they inhale and the abdominals don’t relax which immobilizes the viscera. With the lack of visceral motion, the scalenes and lateral motion of the ribs have to compensate, which can ultimately lead to excess stress and pain. (Rattray, 2000, p. 34). Poor diaphragm function can also cause low back and spine issues because of the diaphragm’s attachments to the lumbar spine.

In an ideal breathing situation, the abdomen will rise first (we want front, sides and back to fill with air), indicating that the diaphragm is functioning as it should. When the diaphragm functions as is should, the accessory breathing muscles elsewhere can relax when they need to and strain will ultimately be much less. Many sources go as far as to say that diaphragm function is the most important of the whole body. In “Clinical Application of Neuromuscular Techniques,” Leon Chaitow states that “the functional status of the diaphragm is probably the most powerful mechanism of the whole body.” (Chaitow, 2008, P. 78)

In “Fascial Release for Structural Balance,” Thomas Myers and James Earls discuss the importance of the diaphragm and proper breathing mechanics in great detail. “One only has to get the ‘wind knocked out’ by a blow to the xiphoid area to realize how useless the other muscles of breathing are without the diaphragm.” (Myers, Earls, 2010, p. 169)

An interesting discussion of exhalation is found in this section. In our sped up and stressed out Western society, very few people have a contraction free exhale. Exhalation is supposed to be a natural process of elastic recoil in the lungs that does not require any action; however, this is often not the case with many people. This can cause stress in unwanted areas. Another problem with exhalation is the diaphragm failing to fully relax at the bottom of the exhale. Many people retain some tension in the diaphragm at all times (can be an issue with poor breathing mechanics) so it never fully relaxes or expels all of the air. Fixing this problem and getting the diaphragm to relax can help the body neurologically, musculoskeletally and organically. Putting the diaphragm in a better starting state can also help with proper function for each breath (Myers, Earls, 2010, p. 171-172) “Small aberrations in the breathing pattern- repeated so many times per day, so many days in a row, right in the middle of the Deep Front Line and the organic self- can lead to many imbalances. The converse is also true: getting the breathing to take a more balanced path can make diverse problems disappear as the body rights itself.” (Myers, Earls, 2010, p. 172)

They also make some great points about the scalenes and their role in breathing. The scalenes are described as the secondary muscles of breathing; more important than the intercostals. “In breathing, they lift the upper two ribs, or prevent them from being pulled down.” (Myers, Earls, 2010, p. 167) Looking at this statement, it is easy to imagine how the scalenes might be affected with an apical breathing pattern characterized by chest elevation. Interestingly, they say that in dysfunction, the middle and posterior scalenes should be divided from the anterior. They say that the middle and posterior scalenes are paravertebral and act as the “quadratus lumborum of the neck” by creating or preventing/stabilizing lateral flexion of the neck. The anterior scalene runs more interiorly from the anterior tubercles of the third through sixth cervical vertebrae down and forward to the first rib- making it more “the psoas of the neck.” It is designed to pull up on the ribs during inhalation. (Myers, Earls, 2010, p. 168) This could have some important implications when designing a specific treatment protocol as these muscles would likely need to be released in order to develop optimal diaphragm function.

As can be seen by looking at all of this wonderful literature, proper breathing mechanics with a properly functioning diaphragm are a big deal not only when it comes to neck and shoulder pain, as we are focusing on with this paper, but for the entire body and many of the processes that occur with it, both neurologically and musculoskeletally.

In conclusion, there are multiple factors that come into play when it comes to working with neck and upper back pain. Some of the most important factors that I found through research and experience have been discussed here. Cervical stresses from postural and structural adaptations, specific muscle imbalances around the shoulder girdle and neck and breathing dysfunction are all very commonly found in individuals with neck and shoulder pain and are very important to assess and address with massage treatment. As mentioned earlier, while massage treatment can help tremendously with specific issues that are found, proper exercises to strengthen weak or malfunctioning areas are just as important so that bad movements and postures can be stopped in order to prevent a recurrence of the issues that were treated. If a massage therapist is not qualified to prescribe and coach the proper exercises and/or stretches, a qualified strength and conditioning professional should be referred to ensure ultimate outcomes for the client. If we continue to research and see more and more benefits and successful treatments with soft tissue therapy and proper exercise/movement, we can help many more people get rid of chronic pain for good!  Hopefully, this project can be a nice start towards a bigger library of research information.
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If I get enough interest, I will post the case study report as well.  Breathing mechanics continues to draw my interest and the more I learn about it, the more intrigued I become.  I am finally taking the first two Postural Restoration courses dealing with pelvic and breathing disoreders the next couple of months and am excited to get even more in depth with things. 



Sources:

Chaitow, L., & DeLany, J. (2008). Chapter 4- Causes of musculoskeletal dysfunction. Clinical application of neuromuscular techniques (2nd ed., p. 78). Edinburgh: Churchill Livingstone/Elsevier.

Earls, J., & Myers, T. W. (2010). Chapter 7- The abdomen, thorax, and breathing. Fascial release for structural balance (pp. 167-172). Chichester, England: Lotus Pub. ;.

Kendall, F. P. (2005). Chapter 4- Neck. Muscles: testing and function with posture and pain (5th ed., p. 159). Baltimore, MD: Lippincott Williams & Wilkins.

Rattray, F. S., Ludwig, L., & Beglin, G. (2000). Chapter 4- Non Swedish massage techniques. Clinical massage therapy understanding, assessing and treating over 70 conditions (p. 33). Toronto: Talus Inc..

Sahrmann, S. (2002). Chapter 5- Movement impairment syndromes of the shoulder girdle. Diagnosis and treatment of movement impairment syndromes (pp. 217-224). St. Louis: Mosby.

Wolsko, Peter M., Eisenberg, David M., Davis, Roger B., et.al (2003). Patterns and Perceptions of Care for Treatment of Back and Neck Pain: Results of a National Survey. Spine. Feb 2003, vol 28-issue 3, 292-297. Retrieved Feb 8, 2011 from http://journals.lww.com/spinejournal/Abstract/2003/02010/Patterns_and_Perceptions_of_Care_for_Treatment_of.18.aspx.

In our last self release article we discussed the psoas and how to release it if it needed releasing. Today, we are going to discuss the quadratus lumborum (QL). The QL is another very important, yet often unthought of muscle when it comes to average fitness circles. Attaching to the top of the posterior iliac crest, the 12th rib and the transverse processes of the lumbar vertebrae, this is an extremely important muscle that helps to stabilize the spine, pelvis and ribs with pretty much any activity you can think of. You can pretty much think of it as either a deep back muscle OR a very deep abdominal muscle. While it technically “hip hikes” or elevates the hip and leg, helps perform side flexion and assists with trunk extension, its true function is generally to act as a stabilizer. Without this muscle, we wouldn't be able to stand upright, walk, run, squat or deadlift effectively. Look at where it attaches and you can quickly understand why. Anytime we hit a single leg stance, the QL should stabilize from the top of the iliac crest to the rib and spine while the glute medius and tfl help control the pelvic positioniong; however, what we commonly see is that the glute medius is often weak with the QL being overloaded constantly.
   
     If someone has any kind of pelvic rotation or shift, one side can very easily become overloaded (I know this from experience as I strained my left QL pretty badly). If the diaphragm and breathing patterns are off course, the QL can be overloaded. If psoas is off course, the QL can be overloaded. If something is off in the foot, the QL can be overloaded.  I think you get the idea, there are many situations that can cause overload of this muscle. To add to that, if it is weak, it becomes even easier to have problems.

    When this muscle strains or spasms, it is a pretty unbearable pain. If you've ever heard someone say that their back went out on them or they got the wind knocked out of them, they probably had an episode with their QL. All that being said, we ideally want the QL to work in conjunction with the obliques, glutes, diaphragm, psoas, adductors and deep rotators to provide adequate support for the pelvis and spine with walking, running, squatting, deadlifting, rotating and standing. When things aren't in good harmony, this muscle can develop some nasty trigger points and adhesions that can cause nagging, annoying and sometimes debilitating pain that can cause plenty of movement and mental problems with many activities. So today I am going to show you a great way to perform some self release on this muscle. As I've said with other things we've talked about, you can release this and you will have some relief, but you absolutely need to figure out what is causing the problem here so that you can prevent problems going forward. Most commonly, glute med and diaphragm need work along with proper fundamental movement patterning to prevent further issues.  If it needs to get stronger or more endurable, exercises like side bridges, side holds and offset farmers carries can get you started.  Get an assessment and take care of the root.

Also went a little more in depth with another video HERE.  It came out blurry so I made the above. 

Give this a shot and hopefully you can get yourself on the road to feeling and performing better.

Happy New Year everyone.  I haven't had a ton of time to get blogs up as of late but will now try to get back on track.  I've been spending my time keeping the gym moving along, getting ready for a meet in 2 weeks and have also started running the strength & conditioning program for Greendale High School.  Anyhow, new post today on the hidden benefits of the face pull and some of its variations.  Enjoy!
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So I think that many people are now aware of the fact that many people need to balance out their pulling exercises with their pushing exercises. Since it is pretty commonplace in our society today for people to sit at desks all day, many people have overly kyphotic shoulders with stiff or short pecs and weak upper/mid backs. In many cases, doing some upper body pulling exercises to train scapular retraction and balance out all of the scapular protraction that these people are stuck in works great.




However, not only do we need to look at protraction (rounded shoulders) versus retraction (open chest, scapulae together) of the scapulae, we also need to look at upward versus downward rotation of the scapulae. While the whole hunchback, rounded shoulders story is pretty common, a lack of scapular upward rotation is also very common. Anytime someone performs shoulder flexion (brings arms straight in front of their body and overhead), the glenohumeral joint has to flex and the scapula also has to upwardly rotate in a nice rhythm in order to reach smooth overhead motion. (Thoracic spine also needs to extend) If the scapula does not rotate up fully, the humeral head will glide superiorly (upward) to compensate and shoulder impingement and pain will result.

Well, if upward rotation of the scapula is limited, then that must mean that the muscles that are in charge of downward rotation of the scapulae are probably contributing to this limitation. These muscles happen to include the rhomboids and the levator scapulae. In addition to playing a part in downward rotation of the scap, the rhomboids also assist with retraction of the scap and both rhomboids and levator assist with elevation of the scap. This means that your typical upper body pulling variations such as db rows, cable rows, etc. can add to the rhomboid issue in someone who has a problem achieving solid upward scapular rotation.(In addition to this, many people also perform shrugs (elevation of the scapulae) with the arms at the side, which could further add to the fire in this situation)  Hyperkyphosis and downward rotation issues can both be present in the same person. So, what do you do to help someone like this? Are they just stuck in this situation forever and have to figure out how to live with it? I think not!!

Enter the face pull. While face pulls are somewhat more commonly used nowadays, many do not realize the great benefit they have that we are about to uncover. With a face pull, your scap is brought into some upward rotation WHILE you retract your scap. This has the lovely effect of taking the rhomboids out of the retraction decently and allows the mid and lower trapezius, which coincidentally are usually weak in a situation like this, to do most of the work with the retraction. So with the face pull, you can help pull this client out of their hunchback of notre dame position and stop their humerus' joy ride at the same time. The stiffened up pecs will be stretched, the stiffened up rhomboids will be stretched (certain fibers at least) and the weak mid and lower traps will be strengthened, helping out both the rotation issue and the protraction issue at the same time. The external rotators of the cuff will also be strengthened, which is usually a good thing. While other muscles such as the serratus anterior and upper traps also need to be looked at for upward rotation weakness (an exercise like a Y may be needed to truly groove the proper upward rotation pattern), these face pull variations can make a huge difference with the situation that we are talking about. 




Regular face pulls look like this. Pull towards the eyes/nose with a palms in grip. Rotate the thumbs back as you pull the scapulae together.

If someone has an imbalance between sides, try the one arm face pull.

If someone has issues with elevation of their shoulder girdle (levator, rhomboids and possibly upper traps are pulling up on the scap), high to low face pulls can help pull the scap down (great to hit lower traps) in addition to the other things already going on with the exercise.

3 sets of 8 to 12 reps usually works good in the middle or end of a workout.  Give these a shot and watch your shoulders get healthier, your posture improve and your back more defined and stronger!!  I will do a blog soon on how to assess proper upward rotation of the scapula and proper positioning of the humeral head with shoulder motion. Hope everyone is off to a positive and productive start of their new year!!

This month's client success story is Dan Joestgen.  Dan is another member of the St. Francis Fire Crew.  Surprise!  If you haven't noticed the trend, this entire crew all makes ridiculously good progress.  They all help to provide a positive environment for each other and push each other to new levels.  Support is everything!  Anyhow, Dan has been training his ass off and is very consistent with his diet day in and out.  As a result of this discipline and determination, Dan has gone from 23.8% to 15.8% bodyfat since February, including 5% just since September alone. He has also dropped from 225lbs down to 210lbs and has improved multiple postural issues. Following this great trend of success, he recently hit an all time PR Trap Bar Deadlift of 400lbs.  Not bad for less than a year of training!!  Congratulations Dan and keep up the great work both in and out of the gym! Peep the pics.

Today, I am reposting an article that I wrote back in May 2011. This article is called "What Do You Do to Better Yourself?" It was a favorite for many clients and readers and thought it would be fun to revisit it. At the time I wrote this, I was still in massage therapy school, was still training out of someone else's gym and was still recovering from my injury and working my way back to heavy powerlifting. I have accomplished a lot since I wrote this and some things have changed so it is pretty cool to read through it and see how I've progressed on some of the points and goals that I talk about in it. If you've read it before, then ask yourself what you've improved on since then or if its your first time reading it, set some new goals for yourself. I'll go over some of the things that I've accomplished or improved upon at the end of the article. Enjoy!!

    Taking care of one's self is of utmost importance to be fully successful and happy in life.  If you don't have your health, everything else down the line will suffer.  If you can't take care of yourself, then good luck taking care of other people and improving their health. 

    Being a strength and conditioning coach and trainer, I am a very busy person.  I train clients 8 to 10 hours a day, five days a week on average.  Sometimes that is nonstop without any real break.  On top of this, I usually spend at least a few hours a week designing and updating programs for current and new clients.  I spend a decent number of hours keeping up with reading and research.  As if that doesn't seem like enough, I also spend time writing either for my website, my newsletter column or articles for other publications.  Oh yea, now I am also going to massage therapy school three nights a week and work in the clinic every other weekend, and on top of that, need time to practice and study.  With all of these things going on, there is no way that I could ever find time for myself right?  Wrong!!!!!  There is never too little time to take care of yourself.  If I didn't take care of myself, not only would I be a complete fraud, but everything else that I do would go downhill.  It all comes down to prioritizing and managing one's time. 

    Too many people make too many excuses for why they are unhappy, out of shape, in pain, don't have time for this or that and blah blah blah.  The fact of the matter is that it is on the individual to make things happen with their lives and to figure out ways to make themselves happy.  Many people work jobs that they hate, get no exercise (and if they do its usually useless exercise), eat like crap, and forget how to enjoy life. 

    Not too long ago, I read "The 7 Habits of Highly Effective People" by Stephen Covey.  It is an all around great book.  A great principle he discusses in his book is "The Time Management Matrix."  This matrix is made up of four quadrants.  Quadrant I consists of urgent, important activities such as crises and deadline driven problems.  Quadrant II consists of important activities that are not urgent such as prevention activities, relationship building, planning, educational activities and opportunity recognition.  Quadrant III consists of urgent activities that are not important such as interruptions, some phone calls, popular activities and some mail.  Quadrant IV is made up of activities that are neither urgent nor important, such as TV, video games, bar hopping, some mail, busy work, time wasters, etc.  

    People who manage their lives by crises spend about 90% of their time in quadrant one and the rest of their time in quadrant IV.  This is not healthy or ideal.  These people deal with excess stress and burnout which leads to a host of other problems (i.e. fat gain, depression.) To try to combat these problems, they go to IV and drink, smoke, etc. which ultimately makes things worse.

    There are also lots of people who spend most of their time in quadrants III and IV.  In III, they work on things that are urgent but not important.  They think they are working on important things but in all reality are basing their own priorities on the priorities and expectations of others. In IV, they are basically doing useless and unproductive things.  "People who spend most of their time in III and IV basically lead irresponsible lives."  In my experience, these are the same people who constantly ridicule others for actually having goals and passions in life because they have none themselves. This is one of my biggest pet peeves. "Effective people stay out of quadrants III and IV because, urgent or not, they aren't important."  By spending more time in Quadrant II, crises and pressing matters in Quadrant I can be limited and Quadrant I will be shrunk.  "Effective people are not problem minded, they're opportunity minded." 

    In my opinion, spending lots of time in Quadrant II is essential to success. Continuing education through reading and research, taking care of your body with exercise, working on your career or business, building important relationships, etc. are all very important activities that improve the quality of life and lead to success.  These are activities that lead towards a major goal. Everybody has to deal with urgent, important activities from Quadrant I but when preventative measures are taken, these things will be limited.  And obviously, everybody needs a little bit of time here and there for pleasure activities from Quadrant IV; most people just overdo it, A LOT.  If you haven't spent time today doing productive things from Quadrant II then get out of Quadrant IV; you haven't earned it.  So what do I do to manage my time and live an effective life each day?
 

    First off, I have big goals and aspirations that I plan on attaining and I WILL reach them.  Nobody will stop me.  I am sure to do multiple things each day to bring myself one step closer to those goals.  If a day goes by where I don't do something to better myself as a person or professional, then to me that is a wasted day.

    I absolutely love working out and training.  I haven't had a gap in my own training in over ten years. I've competed in powerlifting for over five years and have consistently trained at least four to five days a week for as long as I can remember.  I lift weights, perform conditioning, perform appropriate mobility exercises and stretches, do my appropriate corrective and prehab exercises, do my soft tissue work through the use of foam rolling and other various tools and work hard week in and week out to stay in great shape.  I eat clean at least 90% of the time and to keep my sanity, endulge with a couple of cheat meals here and there. I am always sure to eat at least five to six meals a day and am sure to get plenty of protein, quality fats, lots of water, veggies, fruits, fish oils and any vitamins I may miss.  Being strong, lean and staying in good shape definitely helps mentally with everything else in life.  It is a lifestyle and has to be a long term, ongoing practice to be in top condition.  Too many people want the quick fix and easy way out.  Having a good, fit body just doesn't work like that. It takes years of hard work and dedication.  My training is one of the top priorities in my life and has been for years.  And guess what, I still have a LONG way to go and  A LOT to learn.  It is a continuous journey and I am sure to do something everyday to inch myself further on down the road, whether thats an intense, balls out workout or an off day where I utilize some tissue work for recovery.
   
    I suffered a back injury that "set me back" with powerlifting.  Did I just sit around because I couldn't deadlift max singles for a little while?  No, I busted my ass bringing up weak points and fixing movement faults that contributed to the injury and previously held back my numbers. I utilized as many recovery modalities as possible to help with rehab. Now, I am almost back to normal and am going to come back better and stronger than ever.   To me, the injury was a required wake up call and stepping stone in disguise to help me get to the next level with my lifting.  I am too driven towards my goals with training to let something stop me.  As a matter of fact, I have been feeling stronger than I ever have before and have been hitting some nice PR's as of late. 

    While my own training is very important to me, my career also is.  I am sure to do something every day to get better at what I do and to advance my career.  I work hard training lots of clients 5 to 6 days a week, reading books and articles, writing, going to class 3 nights a week, attending seminars and doing anything that will help me learn and get better.  Dan John says "If it is important, do it every day."  Call me crazy, but learning is extremely important; therefore, I do it every day.  Bill Hartman is pretty much the smartest man I've ever had the opportunity to spend time around.  Everyday, he used to ask me what I learned that day.  I took that to heart and now am sure that I can answer that question to myself every single day.  There are a lot of knowledgeable people out there that are a lot better than me.  I would be stupid if I didn't make the effort to soak up every single piece of knowledge that I possibly can.  There is always more to learn and there is always room to get better and grow.  People who "know everything about everything" rarely get very far in life. How many people do you know who actually spend time reading something educational? And I'm not talking about Shape, Muscle and Fitness or Glamour.
   
    I am also just finishing up "Think and Grow Rich" by Napoleon Hill.  This book is basically a classic business and success book that many successful people have read.  In one section, he discusses some of the major causes of failure.  One reason that jumped out at me that I have witnessed in people many times is the following.  "Lack of a well defined purpose in life.  There is no hope of success for the person who does not have a central purpose, or definite goal at which to aim.  Ninety eight out of every hundred of those whom I have analyzed had no such aim.  Perhaps this was the major cause of their failure."  NINETY EIGHT OUT OF ONE HUNDRED!!  That is pretty huge.  If more people had goals, aspirations and passions, the world might be a happier place. 

    If you don't currently have something you are aspiring towards, perhaps you should do some soul searching.  I think that a lot of people have things that they want to do or once wanted to do but just didn't have the courage to make them happen.  Now is the time to make something happen.  Its on you.  Simple minded people will always try to bring you down to their level because they can't understand what you are doing.  Guess what?  Screw em.  Do your thing and don't let anybody stop you or hold you back.  Wanna get in shape?  Get in the gym and make it happen.  Wanna work for yourself?  Find out what you need to do and make it happen.  Wanna get better at your profession or better yourself as a person?  Turn the tv off and pick up a friggin book for once.  Make things happen for yourself!!!!  Forget all the haters!!!
    

_     I absolutely love what I do for a living.  I am able to do something every single day that I am passionate about.  I help all varieties of people from all walks of life move better, feel better and perform better.  It is a 24-7 deal for me.  I truly feel blessed to be able to say that I get to do something that I love every day.  I do a lot of work with muscular imbalances and corrective exercise and am absolutely intrigued by soft tissue work and its effectiveness to help with these things. It truly is amazing stuff! I have learned tons through school this year. Massage therapy is going to be a huge addition to what I do and I love doing it after ~8 months of practice; however, it is one more chunk of time that is taken up and one more activity that could possibly add in fatigue.  This makes staying on top of my own recovery modalities and time management even more important. 
  
    Managing my time wisely allows me to stay on top of all of these things and still have some downtime.  If I have clients 8 hours and class 4 hours one day, I simply set aside 30 minutes here and 30 minutes there to get programs done.  If I have fewer clients one day, I'll plan my workout there and get some reading and massage practice during any breaks.  If I know I am going to be booked solid for most of the week, I mark time off to get my own workouts in.  Since my weeks are so busy, I almost always take weekends off (though sometimes I have clinic for massage).  This allows me to get effective workouts in, catch up on reading and programs, get odd jobs done such as washing the car, doing things around the house, etc and downtime to watch a movie, go out with friends and just relax.  Taking leisure time here and there during the week is important also as going non stop 24-7 all the time would be a surefire road to burnout.  What helps me is the fact that I enjoy what I do and enjoy all of the reading and continuing ed outside of training so I generally don't get stressed out. 

    One other major thing that is overlooked by many people is the importance of sleep.  I usually try to be sure to get to bed at a decent time and not to schedule myself too early so that I can get enough sleep and recover from everything that I do.  I don't think I would get too much accomplished if I walked around like a zombie all day. 

    If you have something that you want to accomplish, make it happen! If you don't have any goals then think of some.  Get a solid workout in, read a quality book, do something special for someone you love, work on your business, do your job better today than yesterday, eat a healthier meal, do something positive to improve and better your life!!

    In conclusion, I ask you: What have you done today to make yourself better?
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    So hopefully this article motivated you or remotivated you to do something great. Since the writing of this article, I have finished massage therapy school, taken and gotten certified in two Active Release Techniques courses, opened my own facility, have gotten back into powerlifting competition, have contributed to a great continuing education product (MIR), have read many more books, attended many more seminars and continue to bust my ass to get better physically, mentally and professionally every single day. Looking at this list of accomplishments, I am pumped and excited to see what I might add to it in another year and a half. I don't write this to brag or boast, etc. I'm proud of what I've done but have a long way to go. I write this to provide some motivation so that perhaps you will get that extra boost that you need to make something big happen for you.

    If I were to write this article today, time management activities would change to actually doing soft tissue work instead of school, and working on my business would be added in. Training clients, my own training, continuing education and studying, etc. all continue to be solid and grow daily. I have new numbers I want to hit in powerlifting, goals for expansion and improvement with my facility and business, more courses I want to take and improvements I want to make as a person. Lately I have been trying to take more time to relax and have fun, which is good to do if you've earned it. Every day is one more stop in the journey and I don't know that the path will ever truly end. Why? Because there is always more to learn, always better numbers to hit and always improvements to make.

    At the time I am writing this, I have a had a very productive day. From 6am to 11am, I trained multiple clients nonstop. At 11:30, I did some manual therapy. From 12 to 2, I trained. From 2 to 3, I studied. From 3 to 6:30, I trained more clients. From 6:30 to 7, I got some stuff done around the gym. For the past half hour or so, I have worked on this reposting/new writing. After this, I am going to go get a conditioning workout in for 20-30 minutes. Then I am going to study again for a little while. Then I will relax and maybe catch a show or game for awhile before I read “The Law of Success” until I get ready to fall asleep. And yes, there was food eaten throughout the day. To some people, this might seem crazy. To me, its just another day closer to reaching more goals.  Instead of making excuses like so many do, prioritize your time, set goals and work towards them. Fyi, similar to training; after a heavy and busy day like today, tomorrow will be a lighter load.  We want success, not burnout :)  Train some clients, get a workout in, write programs, etc.  Just like training, you can't go crazy hard with work every single day either.  Work and train hard, but also work and train smart.

    Surround yourself with others who think like this and you will go far. I am blessed to have a lot of positive, successful minded people within my circle that help with advice, motivation and success and would not be where I am without their help. Many people out there surround themselves with too much negativity and it becomes locked into their minds. Don't let others bring you down. Spend time with people who bring you up and who are better or more knowledgable than you. I see this time and again with clients. Those who are the most successful reaching their goals always have a solid support group both in and out of the gym. This is a must. Make every day a great one, keep getting better and make sure those around you are of the same mindset. Get after it.

So again, I ask you. What have you done today to make yourself better?

This month's featured client is Palmer Middlecauf.  I've had the privilege of working with Palmer for about 3 years, starting off at his house in Kenosha when he was around 10 years old.  Palmer is a competitive figure skater.  These past 6 months or so, he has put forth more effort than I have ever seen from him and has a new determination that is great to work with and see.  His hard work is paying off and it shows in his strength, his posture and his on ice performance.  Palmer competed this past weekend and he and his partner qualified for Nationals.  He has come a long way since we first started out and it is always awesome to watch younger athletes adapt and grow both with their bodies/training and as people as they mature.  He is now a teenager and since he has a great base of patterning and structural adaptations under him, he will be able to push to awesome levels with his off ice training and will become unstoppable on the ice.  I can't wait to watch.  Congratulations to Palmer.  Keep up all of the hard work and you will go far!! Get ready to dominate Nationals.  

Here is a video of one the dance performances that he and his partner did.  One thing that I can definitely notice in these performances compared to some of his earlier stuff is the great improvement he has in hip and pelvic control and also his overall posture, especially up top. He is beginning to own his movement, which is a huge deal.  This has shown both in the weight room and on the ice.  I have an article I put together on off ice training for figure skating and will post that soon so stay tuned. 

    If you've ever read any of my writing, you've probably come to realize that I love learning, studying, getting better and perfecting my craft. I love what I do and make it a point to learn and get better every single day. I recently attended my second ART course in San Diego a couple of weeks ago. For those of you that don't know, Active Release Techniques is a specialized treatment that involves the practitioner putting a very specific tension on an adhesion while a muscle is shortened, followed by the muscle actively being lengthened through its range of motion away from the adhesion. This method is extremely effective for freeing up fibrotic tissue that is causing pain and movement faults. (read my Got CID? Article if you haven't already for more on this) There are hundreds of specific protocols to free up muscle, ligament and nerve entrapments with an upper extremity, lower extremity and spine course making up the big 3. I did the upper course last year and just completed the spine course. Now, before I got into massage therapy, ART was one of the big things that I wanted to be able to do and was a huge driver for me making the final jump into the world of soft tissue. What I would like to do here is provide a little review about the ART courses I've done and what I've experienced with it as a treatment modality.

    This technique is very similar to an old school method simply known as “pin and stretch.” Some people seem to think that ART is nothing more than pin and stretch with a patent on the name. In my experience, this could not be farther from the truth. ART treatments involve very specific palpation, contact, tension and motion with each protocol being unique with the specific entrapment that is being treated. Over the years and through tons of experience, Dr. Leahy (creator of ART) and colleagues have discovered many common/specific entrapments that occur between fibers of a single muscle, fibers of adjacent muscles, fibers of a muscle and a nerve, fibers of muscles and ligaments and even joint capsules. If a practitioner is good at finding local entrapment sites through touch and palpation and is able to perform the treatment correctly, it is insane how effective this treatment can be. Chronic pain can often be ridden of in a few treatments. Specific protocols have been developed to treat common entrapment areas for many common problems such as carpal tunnel, plantar fasciitis, tennis elbow, back pain, headaches and issues associated with many activities such as desk jobs and multiple athletic activities.

    What is also unique about this treatment is the “combo” movements that it employs in order to facilitate relative movement among adjacent tissues. For example, the rhomboids and serratus posterior superior can get stuck on eachother and cause issues in the upper back. With ART, you can get them to move and slide relative to one another, assisting scapular and neck movement. This is not something that can be done very effectively with your typical stationary massage modalities.

    Now, ART is not the end all be all of soft tissue treatments. There are many great tools and modalities that can and should be used for different cases.  In my opinion, it is an amazing tool that most manual therapists should most definitely have in their tool box. It is definitely one of the most effective ways to treat areas that need release. The tension combined with the active motion not only effectively breaks up fibrotic adhesions but also stimulates the body neuroligically and can awaken and retrain sleeping muscles.

    Another great thing about ART is the mastery of anatomy. Since the protocols and the treaments are so specific, you have to know your anatomy inside and out or you will be lost, suck at doing it and fail the course. You learn and get better with functional anatomy and learn how to develop a good contact and tension that treats tissues extremely effectively. Pretty much every muscle, nerve and ligament from the feet on up are involved in these treatment protocols and you have no choice but to get good with anatomy. With any manual treatment, the therapist should always know what they are touching and treating as very subtle mistakes can cause big effects on the body. As unfortunate as it is, this is not always the case with therapists.

    What this course will not do is teach the why behind the treatment. Sure, you are finding fibrotic areas with tissues and treating them, but you still need to be able to figure out WHY they are fibrotic. What caused them to have this issue? You need to have a solid assessment approach to determine what is going on with the body and movement as a whole in order to determine where your treatment should focus and then what should be included in the exercise program to prevent the issue from coming back. So someone has very tender scalenes full of adhesions and inflammation. Why are they like this? Maybe their breathing pattern is off and their diaphragm isn't working how it should be; therefore, the scalenes are working overtime to elevate the ribs all day and are a problem because of this. Treat the scalenes all you want but until you fix the breathing pattern, you'll be treating them over and over again. This is obviously just one example.

    That being said, IF you can figure out whats going on with the big picture, then ART is definitely one of the most effective modalities for helping to restore proper function and get rid of pain. The instructors will even come straight out and say this if you attend a course, which I like.

                                   Releasing these                 and                          activating this    can be a beautiful relationship             

    Now, for a little review on the course itself. I've attended the upper extremity course in Chicago last year and the spine course in San Diego a couple of weeks ago. They were both amazing learning experiences. Now, when you sign up for a course, you get a book and dvd to study and practice with before attending. I usually spend a few months going over the material so that I have it pretty well mastered before attending. There are just under or over 100 some protocols for each different course. If you don't know the stuff before going, good luck! So you learn a ton before even attending. What amazed me is the significant amount that I improved my contact and skill after a 3-4 day hands on seminar. The instructors at both courses were amazing and know the body inside and out. I improved my ability to locate and palpate specific tissues, improved my specific contact and tension for each specific treatment and improved myself as a hands on therapist ridiculously. Like anything else, the more you practice the better you get. So the course helps a ton and you then take those skills and perfect them on clients. I have personally had great success using ART to get people out of pretty chronic pain and even acute pain or a movement fault from a bad movement on, say, a set of squats. When combined with the proper movement and exercise training, this stuff is wicked effective. Forearm problems, back issues, headaches, shifting or rotating in a squat, poor hip extension; you name it and this stuff can help.



    Whats cool though is that you even help other modalities outside of ART. My touch and palpation skills have improved so much that I feel that I have gotten better with other modalities as well, which is a very great thing!!

    Another great thing about these courses, like many courses, is all of the other great motivated professionals that you meet and network with. I met lots of great people in San Diego, many of whom I will probably stay in contact with. Great strength coaches and therapists like Kevin Neeld, Brad Lecraw, John Rusin, Jeremy Ward and Tara Parsons to name a few. Everybody always has something to offer and advice to give out so between the instructors and other students, you have no choice but to get better. I even had a great time just hanging out with new friends when we were done for the day. Just a great overall experience! Any time I attend a seminar, I always come out of it feeling refreshed, rejuvenated and ready to make myself, my clients and my business better than ever. This San Diego seminar definitely did that and more.

    So, if you are a manual therapist in any way, shape or form, I highly recommend taking an ART course. It will take your mastery of anatomy to another level, improve your touch and hands on skills and give you a great tool to put in your toolbox that can help improve client's lives significantly.

    Next up for me is the Postural Restoration Institute's myokinematic and respiration courses. I have heard and seen some amazing things from their stuff and look forward to growing my toolbox with some more new skills. I also plan on checking out David Weinstock's Neurokinetic Therapy and would like to do one of Thomas Myers' Anatomy Trains/BodyReading/Fascial Release courses as well. Always so much more to learn!!! I just turned 27 yesterday and as I think back to how much I've learned and gotten better at what I do since I started working with the body at my age now, I can only imagine how much I can learn and get better with by the time I'm, say, 37 and so on, so forth. It has been, continues to be and will be an exciting journey for sure. I look forward to every step of the way.

    In closing there are some main points that I have taken away from the courses that might help you. Some are new, some are things I've improved with.

    *Use a flat contact, don't poke your client

    *Generate tension, don't compress. Do this using your whole body, not the thumb or hand.

    *Use an appropriate amount of tension for the individual, the tissue and the treatment at hand

    *For many treatments, allow the movement to help create tension. Too much on your own can hurt the client

    *Give tissue time to free up. Don't rush

    *Don't forget about breathing. Deep breathing helps tissue to relax easier.

    *If you are not sure if you are on the right muscle, have your client fire it and get good and differentiating what is what.

    *Understand the anatomical layers and know how to differentiate the amount of depth you use with your contact. (i.e. erectors deep to rhomboids deep to trapezius in the upper back)

    *Learn how to feel nerves and whether or not they are sliding correctly (This is one area I'm working on getting better with)

    *Develop a feel for relative motion between adjacent tissues

    *Don't do more work than is needed to get the job done.  Just like training, doing too much can be detrimental rather than helpful

    *If something is not holding, then look elsewhere to fix the problem

    *Understand repetitive motion injuries and how they change tissue. Read my Got CID? article for more on that.


I could go on forever but these are some big bang points that, without getting too specific and in depth, can help out with many people.

Get better everyday and enjoy the journey.