So I’ll just come out and say it: I’ve started training for a 25k trail race. (For those of who don’t think metric, that’s 15.5 miles or so.) I wanted to use this space to share my weekly training with you, but I first wanted to start by sharing a bit about myself in terms of my athletic background, my inspiration, and my training plan
I ran competitively for 10 years, and when I stopped racing, I pretty much thought that I was going to be done forever. To say that I was a headcase would be an understatement. I’m generally a less anxiety-ridden person (extra emphasis on generally and less). I’ve also been able to put racing and training into perspective. When i get into something, I get really into it to the point of total consumption. For 10+ years I only ran. Then I decided that I was inflexible so I started yoga, though running was still the most important part of my day. Then I decided that I was weak, so I almost exclusively did some type of weight training for 4ish years. I would still periodically come back to running, because one thing that I couldn’t deny was that I loved the feeling. Over the last few years, I’ve done a mix of running, yoga, and weight training with the addition of hiking, but even then, I would be consumed by 1 of them for a few months. Temperance is not a strong suit of mine.
More recently, I have been so inspired by so many of my patients. I hear about their training; I’m a part of their training and recovery; I get invested in their training and racing. First, it got me to transition some of my hiking to some running, and I quickly fell in love with trail running. So gradually, I’ve been doing a bit more of it. Well really, I’m kind of a weekend warrior. I choose to work long hours during the week, which leads to the majority of my running/hiking to the weekends. Regardless, I’ve been really enjoying these past 2 or 3 months. I’ve been enjoying telling my patients about it, and they’re all quick to ask what race I’m training for. Well nothing really. But over the past 3-4 weeks, with each passing inquiry, route planning, run, and discussion of my run, I’ve been getting more and more excited about trail running. It’s all because of my patients. The people that I’m helping are helping me.
My training plan
So since I’ve been feeling more inspired, I’ve been thinking about transitioning my running into something with more structure. I started thinking about it being more like training. I think training implies that there’s a plan. I currently have no plan; my schedule looks like 2 massive mileage days on the weekends (about 23-27 miles over 2 days, hence the weekend warrior status), 2-3 days of yoga, walking to/from work, and inconsistently lifting weights.
So I decided to create some structure and simultaneously practice some temperance. I regularly help my patients to balance their endurance activities with mobility and strength work. I should really be no exception, so I want my training to be balanced between running, yoga, and weight training. So here is the general idea:
3 days a week of running/hiking
4 days a week of yoga
2 days a week of weight training.
I will detail my training each week. I realize that what I have planned is a general template, and that it will need to be adapted. I only wrote 4 weeks right now for that very reason. I will get a baseline in this first month. At the end of each week, I’ll be writing a post about my training including what I did, how it went, how I felt, and if anything needs to be adjusted. I hope you follow along, and I welcome any comments, suggestions, and questions!
A Coach's Guide To Hacking Movement
I wanted to take a moment to speak to the following scenario: you have an athlete that looks like they’re incapable of squatting without falling over. Do you prioritize flexibility, spend time on developing technique, or just program a variety of types of squats using high reps to build strength? Unless you have some specific information pointing to an obvious solution you should almost always assume ignorance first.
So much valuable time can be saved by assuming that the athlete simply just doesn’t understand the movement. If you don’t take the time to clarify technique and instead you move forward assuming that the athlete is just weak, you will not only waste time heading down the wrong path, you run the risk of strengthening bad technique. Always start with technique.
Let’s pretend that you’ve ruled out bad technical understanding. What’s next? Move on to mobility. Is the athlete even capable of getting into the required positions? Imagine a back squat, if you will. The athlete has demonstrated that they understand how to back squat, but they still don’t look right while squatting. Did you take the time to see if the athlete can perform an air squat? Can they even perform a goblet squat? Strength is what helps you to move between two points. Flexibility is required to get into both points. Once you’ve ruled out bad technique, focus on flexibility.
Once you’ve ruled out both technique and flexibility you can move onto strengthening. Now, that doesn’t mean that you have to work only on one of the three at a time. You most certainly can work on all three concurrently. What you can’t do is strengthen the back squat when the athlete lacks the required mobility to perform the back squat. But I didn’t say you couldn’t strengthen split squats if the athlete is capable of that. You most certainly can identify variation lifts to strengthen while simultaneously developing technique and flexibility for other lifts. That simple statement is the most complicated part of coaching.
Looking For A System To Help You Move Better?
Sign Up For The Next PrePose Method Class
Mindfulness has become a hot topic. In life, and in fitness, people are being told to be more mindful, or present, in each and every moment. But what is it? How do you achieve it? Mindfulness without specific directions is a meaningless word.
I recently attended the PrePose Method launch. This new system, developed by the brilliant minds of Dr. Chloe Costigan and veteran yoga teacher Carrie Morgan, directly addressed the absence of mindfulness in human movement. In their systematic approach to mindfulness, skillful movements are deconstructed down to their simplest biomechanical pieces, and then transitioned into PrePoses, or corrective exercises, before ultimately layering the pieces back into the full movement. Breaking down skillful movements into biomechanical pieces creates a common language to build more complicated movement from. The PrePoses use that language to bridge the gap between the biomechanical pieces, and more skillful movements. The inaugural PrePose class focused on bringing mindfulness to yoga poses, but it also showed how the method could be directly applied to any skillful movement. At Mobility-Doc we’re already using the PrePose method to teach weightlifters how to achieve a better overhead position with a barbell.
PrePose taught me that mindfulness can be achieved when you have a system that helps you to constantly check back in on the most important parts. That without a common language coaches and healthcare professionals run the risk of their cues getting lost in translation. True movement efficiency is subconscious. But before you can achieve that you must first be made consciously aware of the movement. You can’t be mindful without knowing what you should be mindful about.
Save time and improve your results with these 5 easy steps.
The barrier to entry that we see with most patients when it comes to stretching, foam rolling, and the rest of the mobility/recovery works is that they don't have enough time to do it. However, your mobility/recovery routine really shouldn't take you all that long. It's often a case of doing too much instead of not doing enough. Here is how you can trim the fat, and still get the best results, from your routine.
I hope you found this to be helpful. Please share with your friends so that I can make a larger difference. If you have specific questions you are more than welcome to ask us. We can't consult on medical conditions without certain formalities in place first, but we can always point you in the right direction. Last year I developed custom mobility programs for two Rio olympians and world team members across 3 different sports. Not to mention for a very large number of our regular patients. I'd be more than happy to do the same for you.
MobilityRx Online Recovery Program
We've helped numerous clients around the world with their movement and mobility issues. Using our video chat software we will speak face to face with you for 30min to get a feel for your issue. Then we will create a corrective strategy fo you. We won't stop until we've got it perfect.
MobilityRx Recovery Program
The MobilityRx program is perfect for anyone who wants their movements analyzed and is looking for a corrective exercise program to take home with them. We've created our own functional analysis using manual muscle testing, isolated range of motion testing, and whole body movement testing. Essentially we will break you deconstruct you into pieces and then put who back together into a story that explains why you are having the difficulty you're having. These visits last about one hour and then we will work on your corrective plan afterwards. You will receive a full narrative explaining what we've found so that you can share the information with whoever you want.
What is PrePose yoga?
It a method based on biomechanics to improve your yoga practice. It was developed by Chloe Costigan, a Doctor of Physical Therapy, and Carrie Morgan, a ERYT-500 yoga teacher with 12 years of teaching experience. The goal is to improve your understanding of the biomechanics to be applied to a variety of poses in your practice. It will help you to identify and address asymmetries or limitations in both flexibility and strength.
Why did we develop the PrePose method?
Your body does its best attempt at whatever it sees or hears, and you try to replicate that. But there was a gap between the instruction and the practitioner’s interpretation. We want to develop a common language for understanding movement. So then you can learn how to adapt any pose to fit your body instead of trying to fit your body into a pose.
How is this different than a typical yoga class?
So to be clear, we love that there are so many amazing studios and teachers in this area. We want you to continue with that. This is a supplement to your existing practice. It’s taking the gray out of the physical practice of yoga by applying physical therapy principles.
You will be in a guided yoga class that teaches you how to fit the poses to your body in a three step format: 1. biomechanical exercises, 2. The PrePoses, or modifications to poses, and 3. The poses. The biomechanics (step 1) teach you a common language of how to move each joint and activate each muscle. The PrePoses (step 2) bridge the biomechanics for the poses by applying the biomechanics to a modified pose. Step 3 puts all of the pieces together.
Who is this for?
Well. Everyone in a way.
It’s for beginners who want to ensure that they’re learning the proper technique.
It is for the experienced yogi who wants to gain a deeper understanding of the biomechanics of each pose and learn exactly what is going on with their joint and muscles from the vantage point of a physical therapist.
For those with a history of pain whether in yoga or a different activity, it will help to identify flexibility and strength limitations on a more specific level.
What will a class look like?
It will be based on a central theme. There will be an upper body and lower body section, each having the 3 step process of 1. Biomechanics, 2. PrePoses, and 3. Yoga poses.
There will be a demonstration to provide a clear visual of the biomechanics, PrePoses, and poses. That way you know exactly what you’re supposed to do. That will be followed by you doing those on your mat while receiving instruction.
Don't miss out on our yoga retreat in Grenada, Spain!
Only a handful of spaces are remaining for this summer.
Every patient deserves to be treated as an individual. There may be some overlap in the treatment between two patients but your experience with physical therapy and chiropractic should not feel like a medical assembly line. Here's an example of how we treat our patients at Mobility-Doc. You can use a guideline for your own care no matter where you live in the world. That's not to say that our way is the only way to help someone, but we get great results, and this is how we do it.
The New Patient Consultation
We spend at least 60 minutes with every new patient. If the case is more complicated it could be longer. Every first visit begins with a doctor seeking to understand three things:
The third question is often the most important one to answer. Its never as simple as just wanting to not have pain anymore. Usually the end goal is layered with beginning or resuming an activity, and reinforced with the proper habits to avoid arriving back to us as a patient. Getting rid of your pain is the easy part. Sustaining an active lifestyle for the rest of your life takes work.
Almost every visit begins with testing three things:
If you didn't read our blog about testing and retesting, then you really should. We teach that concept to all of our patients, and it's the guiding force for our treatments as well. If your doctor isn't physically examining you on some level then I'm not sure how they know if you are improving or not. New patients may go through some functional capacity testing or a movement screening. Something more in depth that we will test again later. The testing might even be specific to a sport or activity. Established patients will almost always go through the basic three tests at the start and end of each visit.
The treatment you receive should depend on three factors:
For our patients we almost always provide hands on physical care. One of the reasons why we've been so effective as a physical medicine practice is that most hospital affiliated rehab centers don't spend enough time physically treating their patients. Instead they push them to do therapeutic exercises from the start. Hoping that the pain or dysfunction will work itself out. The issue is that you can't build strength and stability in the presence of pain or dysfunction. The main reason why typical therapy settings push patients to do therapeutic exercises, often never physically touching the patient, is because they can see more patients and make more money with therapeutic exercises. Don't fall into that trap. Here's a blog we wrote explaining that idea in more detail.
Therapeutic exercise is a generic term for the strength, stability, and flexibility work that you do during your appointment. We will use another blog to go into greater detail about what exercises you should be doing. For the purposes of this blog all you need to know is that at Mobility-Doc we take pride in developing customized rehab protocols for every patient. We don't follow the same script for everyone. There will be some overlap, but we don't hand everyone the same sheet of paper and then send them to their respective corners to perform their exercises. Avoid practices where everyone is doing the same exact thing.
There are many wonderful physical medicine practices out there but it isn't always easy to find the right one. Hopefully you can use our outline above as a reference point during your search. Also, do your research about the doctor and the practice. Read the reviews from previous patients. At the end of the day, even if you become a patient at Mobility-Doc, the only thing that matters is if you are getting better or not. It takes the right intervention, not just any, to help a patient.
At Mobility-Doc a large number of our patients and clients come to us seeking out a better system for improving their ability to recover. What we've found is that the problem isn't that most people aren't doing too little stretching and foam rolling. They are going in blind and doing too much of the wrong thing. You might think that the book or the app you just purchased is giving you a system, but most likely it's not. Take a closer look at it. At best you've probably purchased a generic template or an encyclopedia of exercises. You need to test and retest. If not you are just pressing and guessing.
Testing and retesting is simple. At least it should be. Remember KISS? Keep it short and simple. Is your knee hurting when you squat? Then thats your test. Pick a mobility exercise and perform it for time or sets and reps. Right after you finish performing the exercise, retest. Did it help? Do more of it. Did it hurt? Stop doing it. Do you feel exactly the same afterwards? Then you're wasting your time. Try to develop a 15-20 minute routine. Once you have what works exploit it until it doesn't work anymore. Let test and retest be your guiding principle.
Looking for professional help?
Almost 50% of our patients are using our affordable private pay plans these days. Some either have tremendously high deductibles, or are out of network, and it's simply more cost effective for them to not use their insurance.
Your insurance doesn't have to dictate the quality of care you receive at Mobility-Doc
The High Cost of Being In-Network
The Mobility-Doc team made a decision a long time ago to never sacrifice the quality of our services for the promise of being in-network. Something that isn't often explained is what it actually means for a doctor to be in or out of network.
The main reason why any doctor's office is in-network is that the insurance company promises that, in exchange for agreeing to their terms, they will grant you access to their very large network of subscribers. The catch is that the doctor will have to agree to whatever payment the insurance company deems as appropriate. For many commercial insurance plans the reality is that they will pay the doctor significantly less money, forcing the doctor to see as many patients as possible in that network to make up the difference. An increase in the number of patients, and a decrease of overall compensation, means less time with the doctor, and a decrease in the value of your care.
Why We Opted Out of Most Insurance Companies
About 7 years ago we tried to be in-network with more commercial plans. The insurance companies wanted to decrease our compensation by 70%, and promised to reward us for treating patients for as little as possible. That last part isn't an exaggeration. The less we asked for more visits for our patients, the easier it would be for us to see new patients. We would be promoted for that behavior. The magic number of visits was the same for everyone, 6 visits. 6 visits to get you better before we were penalized. It's no wonder why so many PT clinics are driven by one-size-fits-all protocols forcing patients to all perform the same exercises in their minimally monitored corners by the legally required minimum of assistants, and almost no doctor ever physically treats the patient. It was then that we decided to opt out of every insurance, except Blue Cross Blue Shield. We don't have assistants. We don't sacrifice time, or quality. One doctor. One patient.
Three Monthly Plans To Keep You Happy & Healthy
It was with all of the previous information in mind that we created our private pay plans. Prices that were fair to both our patients, and to our business. Prices that made it so that we could spend as much time as needed with every patient. Our medical practice has existed for over 30 years. We are family owned, and operated. We provide customized care for every individual. Most patients are in our office for at lease one hour. The goal at Mobility-Doc is to make sure that no person ever has to give up on their active lifestyle. No matter what their insurance thinks about the value of their health and happiness. Our patients range across all ages, a wide variety of muscle and joint injuries, and across the entire spectrum of athletic ability. There are patients in their 80s who just want to play with their grandchildren, and their are USA world team members across multiple sports.
You can be a patient at Mobility-Doc for as little as $45 per visit
With our private pay options you can pay as you go, or, after your initial visit, you can purchase a month's plan for 1, 2, or 3, appointments per week. You can be a patient at Mobility-Doc for as little as $45 per visit
4 $55 Wellness Session / Month
Save $100 on four sessions in one month when you purchase your visits ahead of time. Typically this equates to 1 visit per week for 4 weeks. Each visit includes anything and everything you need to get better. Every service we offer is at your disposal. This is reserved for existing patients only. New patient select initial consultation.
8 $50 Wellness Sessions / Month
Save $240 on eight sessions in one month when you purchase your visits ahead of time. Typically this equates to 2 visits per week for 4 weeks. Each visit includes anything and everything you need to get better. Every service we offer is at your disposal. This is reserved for existing patients only. New patient select initial consultation.
12 $45 Wellness Sessions / Month
Save $420 on twelve sessions in one month when you purchase your visits ahead of time. Typically this equates to 3 visits per week for 4 weeks. Each visit includes anything and everything you need to get better. Every service we offer is at your disposal. This is reserved for existing patients only. New patient select initial consultation.
Initial Consultation or 60-75min visit
This option is mandatory for all first time patients and for anyone who just wants one session that will last about 60-75 minutes.
I figured I wouldn’t beat around the bush. If you know me (Chloe), you know yoga is very near and dear to me.
I want to highlight a few reasons about why you should care about yoga.
And then I’ll also give you some more details about the yoga retreat I’m hosting with Carrie Morgan, ERYT-500 in Granada, Spain from June 10-17th!
So here goes. Why you should care about yoga:
1. It can help prevent injury. Regardless of what you do, when you move intelligently in your body you can prevent injury. It gives you the opportunity to assess your body: is the right side as stable as my left side? Is my decreased right trunk rotation impairing by ability to extend through my hip and use my glute? Then when you correct these areas, you'll be able to move better whether that's longer, faster, stronger.
2. It's a physical and mental act. It’s as simple and as complicated as this: if you are more mindful (you know that buzz word everyone is saying now) in the way you move, you can begin to see parallels across activities and different aspects of your life. Moving your body with intention allows you to move intelligently and with purpose. Oh and you may get that added benefit of getting out of your head going over your never ending to do list and upcoming plans etc.
3. It's comprehensive. It mixes flexibility/mobility and stability/strength. It utilizes your upper body and lower body. You use your body as the tool. You only need a mat and some comfortable clothes (and really the mat is optional and sometimes the clothing really isn’t so comfortable or practical and you promptly switch that). You can find so many ways to challenge your body with different types of yoga and poses.
4. It exists along a spectrum. In terms of physical fitness, you can read an article one day saying that one type of exercise is the best and the very next day (or same day, really) saying that it's terrible for you. How about if we just appreciate that exercise exists along a spectrum? If we are considering the physical aspect of yoga, we can say that you can practice yoga along a spectrum. Everyone has to start somewhere. It can be more challenging to less challenging. You can focus primarily on flexibility. You can focus on strength and muscular endurance. Or you can do both. It affords a lot of flexibility (see what I did there?)
The take home is that there is a place for your yoga practice in your already busy life. It can and will take on many shapes. And in a world of so many expectations and “should’s”, this is willing to meet you where you're at, regardless of your goal (or even the lack of goal).
You can explore these benefits on a yoga retreat with myself and Carrie Morgan in Granada, Spain from June 10-17th, 2018. I wanted to answer a few FAQs.
I’m sure you’ve asked yourself a few questions like:
Who is it for?
This retreat is designed for experienced and new yogis alike, because really, the thing we care about is movement. Anyone can benefit from moving better. Yoga is the platform we’re using to expose you to better movement and identifying your strengths and weakness regarding flexibility and strength.
What will from the yoga portion of the retreat?
You'll have 2 yoga-based classes per day. You'll start with a theme based flow designed by Carrie Morgan, who is one of the most experienced yoga watchers in the Lehigh Valley. This theme will be focused on a specific muscle or body region: think hamstrings, hip flexors, spine, shoulders. Then, Carrie and I will help you to learn more about your own abilities in terms of flexibility and strength. I will use my experience in treating yogis and practicing regularly to help you to identify areas to work on. We’ll help you to understand what is supposed to be going on in a pose. I will help you understand areas for improvement of your flexibility and strength. I’ll tell you what to do about it with very specific corrective exercises. You'll be able to discuss these areas with Carrie and myself.
What will my day look like?
Well for one, you'll wake up in beautiful Granada. You'll practice yoga; you’ll move, you’ll learn. Then, you'll explore. We planned 4 excursions for you that cover a variety of activity from visiting the Alhambra palace to flamenco dancing to city exploring to relaxing on a beach. You’ll have all 3 meals provided for you as well. They’re all locally sourced, seasonal meals that can accommodate to your specific dietary restrictions. You’ll be able to relax on the beautiful and scenic Lucia Yoga Retreat Center proper and enjoy your air-conditioned room accommodations. You'll find it's the perfect mix of activity, exploration, relaxation, learning, and, oh yeah, yoga!
So why choose this retreat?
For the experienced yogi: It's the perfect way to take your practice to another level. You have a physical therapist who regularly treats yogis and one of the most experienced yoga teachers in the Lehigh valley helping you to learn more about your practice and to move better. You can think of it as a yoga intensive mixed with a fabulous vacation. Oh and bring along your friend or spouse; you'll love exploring with them. They'll thank you
For the new yogi: This is your opportunity to take advantage of all of the benefits of yoga that I previously detailed above. You’ll see how it can enhance all of your movement, and you’ll find the mix of flexibility/mobility and strength/stability work that suites you best right now. You’ll be able to figure out how this can enhance your typical exercise and activity routine. You’ll have the opportunity to do this while taking time out from your busy life to give this the time it deserves.
If you have any questions, please don’t hesitate to reach out to Carrie or myself. Our emails are firstname.lastname@example.org and email@example.com
Visit The Yoga Loft for more info!
The Mobility-Doc Blog
Drs. Chloe Costigan and John Giacalone are both physical medicine specialists, former competitive athletes, and strength and conditioning coaches.