Runners, cyclists, and just about anyone who moves their legs on a regular (or irregular) basis has probably encountered the Iliotibial Band: a dense, fibrous tract of tissue running from the outside of the hip along the side of the thigh to connect just below the knee. And if you have experienced sensation associated with this tissue structure, chances are high that it was not a good experience.
IT Band pain symptoms and range of motion inhibition, often referred to under the umbrella term “IT Band Syndrome,” is a common condition among individuals who engage in repetitive leg flexion and extension, and while exact figures for the entire population are unknown, some studies estimate prevalence over 20% in people who run or walk long distances. Symptoms usually present with pain in the lateral hip or the attachment at the knee, although sometimes tissue adhesions in the side of the leg cause pain when the structure is stretched, as in running or cutting movements.
The IT Band is itself not a muscle — structurally, it can be thought of as a long tendon tail attaching at the bony prominence at the top of the lower leg, just below the knee (at the prominent knob of the lateral head of the Tibia bone; it probably hurts a bit if you press on it), running up the side of the thigh, and fanning out to blend into the Tensor Fascia Latae hip muscles and Gluteus Maximus, which finally attach at the Iliac Crest, the upper rim of the pelvis (hence ilio-tibial). Like all tendons, the IT Band has little blood supply and nerve innervation, and is primarily composed of collagen, elastin, and fibroblast cells. While it cannot contract on its own, the muscles at the top of the hip (primarily the Tensor Fascia Latae) put tension on the IT band to abduct (bring away from the body’s center line) the hip and leg. Think of a rope and pulley system — the rope in this case represents the passive IT Band structure, serving to distribute the force applied to it from the other side of the pulley. This is particularly important in walking and running, where the leg involved in stepping forward during the “swing” phase of gait relies on the abductors and deep lateral rotator muscles of the hip to keep the pelvis level and stable. You may have seen runners or walkers whose hips “dip” with every step — this often indicates dysfunction in the Tensor Fascia Latae and hip rotators.
It is important to view the above graphic as a representation of the actual structure within the body; I like how the artist has indicated that the white tendinous fibers of the IT Band blend into the muscle tissue at the hip, but I think the characterization of the IT Band as a separate bundle of tissue laying on top of the surrounding muscle is a common misunderstanding, and refining our concept of the IT Band as it actually exists and functions in the body has great implications for practitioners and athletes alike.
Our understanding of human anatomy comes largely from dissection of cadavers, wherein individual muscles and anatomical structures are identified by being excised with a scalpel from the surrounding tissue. This gives us a detailed sense of the three-dimensional body, but by manually separating the tissue, we also often tend to mentally isolate these structures and forget that the elegant, intricate musculoskeletal system recruits fibers from a broad range of tissues for almost every motion. Take a look at Leonardo da Vinci’s drawing of a dissected leg to the right (click to expand to full size). This intricate and amazingly accurate drawing from the early days of human anatomical study indicates the same fanning connective tissue structure in the upper hip as it blends with the hip abductor muscles, but we don’t see the same IT band structure drawn separately from the surrounding tissue — it’s more of a thickened strip of tissue that forms a groove in the side of the thigh. You may have seen athletes with highly defined, sculpted musculature who exhibit the same structure; the IT Band appears as a groove along the side of the thigh and forms a tendon bundle at the tibia attachment. Just as the connective tissue structure of the IT Band blends into muscle at the hip attachment, there is also a great deal of “feathering” into the muscles of the lateral thigh — namely, the lateral quadriceps and hamstrings.
Why is this distinction important? To go back to the previous rope and pulley analogy, we can refine this understanding to not just a single rope pulling on a single endpoint in a single plane of movement, but a network of pulleys pulling on a web of ropes that disperses tension across a wide area, with each structure interacting as tension is applied and released. The interactions are so intricate that even the most sophisticated biomechanics models can only provide simplified schematics of the forces at work in the living body. You may have seen similar art and architectural structures, called “tensegrity models” that exemplify this concept. Below is a video of renowned bodywork practitioner, researcher, and teacher Tom Myers showing an example of a tensegrity structure and how it relates to the body:
Watch how the model moves when Tom pulls on a piece of the elastic thread — look closely and you will be able to see other elastic threads disperse tension, with some going taut and others going slack, which changes the position of the rigid dowels. The model demonstrates how a rigid structure with limited elasticity can affect the contractile structures it attaches to. An example of this in practice might be flexion of the hip to kick a soccer ball. As the leg is brought up and the angle of the hip becomes more acute, the quadriceps fire to extend the knee and flex the hip. Since these fibers tie into the IT band, this motion exerts force along the length of the IT band, which will functionally rotate the leg inward (medially). To prevent rotation, the deep lateral rotators that run across the glutes must fire to compensate. This is a simplified explanation of the processes at work, but is meant to demonstrate the kinetic chain of events that occurs with movement and the forces at work to stabilize and compensate to promote strength, accuracy, and protect against injury.
Taking this same example a step further, suppose one of the muscles working in concert to accomplish the kicking action is weak or impaired due to injury or improper training. The Piriformis, one of the deep lateral rotators of the hip that runs beneath the glutes from the Sacrum to the Femur, is a common offender for hip instability and insufficiency. Without the Piriformis firing properly to prevent medial rotation, other muscles that may not be as well adapted for hip rotation must be recruited to preserve stability, including the Tensor Fascia Latae. The IT Band, already under tension from its connection with the Quadriceps, comes under additional tension from the Tensor Fascia Latae to pull the leg into alignment, putting even greater stress on the IT Band attachment at the knee. Can you see how this could lay the groundwork for pain, inflammation, and chronic injury?
The prescribed treatment for pain and tightness in the IT Band has long been stretching, manual therapy, and foam rolling along the length of the outside of the leg, which still assumes the concept of the IT Band as its own discrete, free-gliding bundle of tissue and discounting the connectivity to the surrounding muscle. I’m making the argument that this isn’t necessarily the most effective nor the best biomechanically sound approach to treating IT Band Syndrome symptoms. Stick with me here.
Think again back to the tensegrity model Tom Myers was playing with. If one segment of the elastic thread was under significant tension, it would produce slack on other thread segments — that’s how vector energy dispersal works. What if, instead of approaching the problem by addressing the tight thread, we look for ways to bring appropriate tension into the slack threads? This accomplishes the same goal of dispersing tension equally, without further assaulting already inflamed, sensitive tissue.
In the case of the IT Band, this translates to gentle stretching and mobilization of the Tensor Fascia Latae — remember, the IT Band itself is essentially a passive structure and translates tension from other muscle attachments instead of exerting any force itself — and rehabilitative exercise to strengthen the deep lateral rotators in the hip and glutes. I am not recommending this as a cure-all approach for every presentation of hip and lateral knee pain; always seek evaluation from a medical practitioner to properly diagnose pathology and pursue the best course of treatment. For everyday tight, tender IT Bands, here are three exercises that target the supporting musculature to promote balance and optimal movement patterns:
First, the Clamshell — the model in the video is using a resistance band, which can be omitted and introduced later as strength and mobility progress.
Next, the Glute Bridge; I like this single-leg variation because it requires more global hip engagement than a symmetrical bridge hip raise. Adjusting the angle of the raised leg (pointing more toward the ceiling) will help to recruit more low back, hip flexors, and hamstrings to maintain balance.
Finally the Triplanar Hip Exercise (one of my clients fondly refers to this as the “fire hydrant;” if you are a dog owner, you will quickly recognize why!). The model in the video has good form but I would recommend slowing down the pace for more accurate muscle recruitment. The three elements are full extension of the leg, lateral rotation, and flexion pulling the knee into the torso.
These exercises are a great starting place to promote hip mobility and strength for runners, cyclists, swimmers, and active individuals in general. You can make them more difficult by taking away the stable base of the solid floor, for which Bosu Balls and wobble boards are excellent tools. These also make a great pre-activity warm-up or post-activity mobilization. If you have sciatica or back pain symptoms, consult a health professional before beginning these exercises, as excessive tension in the deep lateral rotator muscles can sometimes exacerbate nerve impingement symptoms. Always stop if you feel pain or pinching, and work within your abilities, progressing as your strength improves.
I hope this perspective on the IT Band sheds some light on its function and structures. This essential tissue mass in the leg is an important factor in all activity and movement, and healthy function will improve performance and prevent injury.
It’s autumn in North Carolina, which can only mean three things: spectacular sunlit leaf color, a distinct uptick in latte consumption, and NCAA college sports in full swing.
I get the privilege of working with several Division I college sports programs, most notably my graduate school alma mater: the University of North Carolina at Greensboro. I’ve been feeling the Spartan love this week with lots of outcall sports massages in the athletic training room, and working with these talented young people never fails to keep me on my toes.
The Internet Age has given athletic people vast resources to learn more about sports, nutrition, physiology, training, and therapies. On the whole, I am impressed that the availability of knowledge seems to help my massage clients to be well-informed and discriminating consumers of information. People who participate in sports at a high level view their bodies as tools — their vehicles for recreation and competition. This insight frequently leads them to constantly seek and evaluate information that will improve their performance, health, and experience. It also means they ask practitioners a lot of questions.
It’s easy to view “why?” as a challenge: a threat to authority and credibility. But forcing myself to dig deep into the body of knowledge through the incredibly effective (and sometimes incredibly annoying) Socratic method makes me a better practitioner and helps me build a reputation among my clients that I am a trustworthy source of information. The college students I work with ask questions that often catch me off guard, and the exercise of thinking analytically and critically to construct a thoughtful answer is often a missing ingredient in massage education.
Let’s apply it to a common instruction massage therapists give to clients following a bodywork session: “Be sure to drink plenty of water after your massage.”
The pat answer many of us learn in massage school is “to help flush out metabolic waste.” But what does that mean, and most importantly, is it a rigorous and factual response to the physiologic processes at work?
To be thorough and deductive in crafting an answer, consider all the pertinent facts. Massage therapy has a demonstrable effect on blood and lymphatic circulation, because the mechanical manipulation of soft tissues introduces heat and pressure, which creates a mild inflammatory response. The body’s response to topical heat is rapid dispersal by dilating capillaries in the tissue, which decreases blood pressure because of decreased vascular resistance. To maintain homeostasis, the body responds to the drop in blood pressure by adjusting fluid uptake in the blood stream and changing heart rate to stabilize blood pressure. One important role the circulatory system performs is transportation of the surplus substances of metabolism and energy production and expenditure to the kidneys to be excreted from the body. An example is the process of converting protein into energy: the leftover substances include ammonia, urea, and uric acid, which are toxic if they remain in the body. Massage is not directly shown to release metabolic waste from soft tissues under study conditions, but in consideration of the peripheral responses to massage, appropriate hydration supports homeostatic processes to promote optimal muscle function and recovery. Most importantly: with the exception of a few conditions such as hyponatremia (abnormally low electrolyte dilution), drinking water is an appropriate recommendation for overall health an wellness; the risks are vanishingly small, and the potential benefits are great.
For many clients, this explanation goes in to way too much physiology detail. However, I think as a therapist, it is important to understand the complete picture and to be able to articulate it accessibly and intelligently. It establishes credibility and develops the ability to think critically and scientifically about the therapeutic intention of our work. It also helps me to be better able to talk about the effects and benefits of massage to other medical providers, which has made a huge impact on building my client base and becoming regarded as a skilled practitioner, able to get into a variety of unique opportunities as a massage therapist. For me, it’s simply not enough to regurgitate pat answers; I am voraciously curious and keeping current on research helps me to continuously refine my methods and understanding.
If you are a consumer of massage therapy, I encourage you to ask your therapist questions about what he or she is doing and effects on the body. I think most therapists are like me — we get really excited when clients show an interest in our specialty and we want to share with you information that can positively impact your health, wellness, and understanding of your body. Learning about physiology and anatomy in school was like getting an owner’s manual to my body and I love sharing that feeling of empowerment through knowledge with my clients. I don’t think it’s appropriate to try to test therapists’ knowledge with “trap” questions, but to approach your therapist as a resource to broaden your understanding of health, wellness, and activity. Additionally, most massage therapists maintain an extensive referral network of other allied healthcare professionals, so even if we can’t directly answer your questions, we can almost certainly direct you to another expert who can.
Do you have a burning question about massage therapy, or are you a practitioner who has encountered great questions from your clients? Shout out below!
Sometimes in life, I have found that intense, completely immersive experiences often need time to be processed before I can appreciate the content with a more objective, analytical attitude without the haze of emotional exhaustion. A slower Saturday morning today has given me that valuable time for reflection and organizing my thoughts.
Working a major race as elite cycling team staff is not for the faint of heart, and I am coming to understand why the turnover in the industry is comparatively low: people who aren’t up to the rigors of the work for whatever reason burn out quickly, and the few who make the cut tend to become career team staff. I’m not sure who works harder: mechanics or soigneurs — both jobs require long hours of exhausting work.
The Tour de Bretagne was a UCI 2.2 stage race, which means a limited number of national teams were invited (in this case, 2: the USA team, and the Australian national team) along with European continental teams, pro development teams, and pro tour teams. It’s a very high-level race in which stage winners and riders high in the overall finish ranks have historically continued on to successful professional careers. The race consisted of 7 stages between 145 and 200 kilometers long over challenging terrain and road surfaces in the rural northern coastal country of France. The six USA national team riders selected for the race were charged with two major tasks: to ride hard and return some good results, but perhaps even more importantly to learn the skills needed to race at that level which professional teams look for in prospective riders. To paraphrase their director, former pro rider Michael Sayers, racing at events like these presents a goal that isn’t necessarily meant to be attained, but for learning to occur in the process of striving toward that goal. Bringing away a couple good results and a wealth of experience constitutes success, and in that respect the Under-23 riders of the USA national team were very successful.
As for my part, my role was to serve as an apprentice soigneur to Robert Grabowski, another alumnus of the pro leagues who worked for Liquigas-Cannondale and BMC world tour teams. We arrived at the first host hotel in the evening 2 days before the race began, which gave me a day to prepare and learn the ropes a bit.
My first task the next morning was bottle prep. The general policy is to distrust drinking tapwater in many parts of Europe, so I had to make a grocery store run to purchase bottled water for drinking and food supplies for the next few days. Every part of the process involved some unforeseen complication; nothing was easy. I drove the van, an enormous Fiat Ducato, down winding narrow French roads (having to turn back twice because the GPS wanted to take me under bridges too short for the van’s height) only to find that the grocery store had underground parking also too low for the van, so I had to parallel park it on the street. For comparison, I drive a compact hatchback Honda Fit back home — the van is roughly 1.5 Fits wide, 2.5 Fits long, and 2 Fits tall. I’m just relieved my parents insisted on me learning to drive a stick shift as a teen; that was the one part of the whole process I felt competent doing. I managed to park the van without running into anything, popped a couple of coins in the locks to retrieve shopping carts (that part I remembered!), and ascended the escalator. An hour and a half later, I had collected 250 liters of bottled water in various sizes of containers and enough groceries for a small army. It took me a long time to identify the translations of food products in an unfamiliar store layout; my basic French vocabulary got me only so far. I negotiated the transaction in my nonexistent French and haphazardly wheeled about 300 kilos’ worth of water and food back down the escalator (a feat in and of itself), drawing copious weird glares from onlookers. With water and food loaded up, I made my way back to the hotel to wrap up race food and bottle prep and begin with rider massages.
The one part of soigneur work I feel thoroughly comfortable performing is sports massage; I’ve been doing it for 7 years and have taught seminars at the graduate level for the last 3, so I feel like I have that part down. It was honestly a relief to be able to focus my energy for a couple hours on something in which I am well-versed and experienced; it’s hard work of a different kind, but work where I don’t feel like I am constantly questioning myself and I take solace in that practice. I am told that coming from a sports medicine background is surprisingly uncommon among beginner soigneurs; many come from another aspect of sport or industry and have to learn the bodywork and recovery component as they go. Having extensive training in what is ostensibly the most difficult and most important part of the job gives me time to iron out the rest of the details, which are complicated to learn but easy enough to perform once routine is more established. It didn’t feel like it at the time, but in that respect I am very fortunate.
The Tour required several hotel transfers, so the plan was for me to get the riders to the race, do the feed zone, and get to the finish to bring them back to the hotel while Robert drove the box truck to the next hotel and prepared all the details. The first stage didn’t require a hotel transfer, so I was able to shadow Robert and learn the responsibilities and layout of a race stage. I wrote this list up during the week, and it is a pretty darn accurate characterization of most of the stuff a soigneur needs to keep in his or her head at all times:
Before the race
- Up early, shower and pack, breakfast
- Prepare race food
- Get baguettes from hotel
- Make sandwiches for soigneur(s), mechanic, and director. Pack in musettes with goodies
- Make post-race sandwiches and rice for riders. Also fill a musette with fruit. Pack condiments, tuna, oil, and utensils for the rice
- Make 2 thermoses of coffee and one of hot water for tea. One coffee for team car, one for riders. Pack cups, sugar, creamer, and stirring things
- Make snack sandwiches with milkbread for riders and pack in aluminum foil. Do one savory variety (ham and cheese is good) and several sweet ones (Nutella, honey, jam, etc). Make 1 per rider with some extras for musettes
- Wrap cake or waffles in aluminum foil for riders
- Restock race food bars and gels
- Prepare bottles
- At least 5-7 per rider — 2 for musettes/feeds, 2 for the bike, and 1 for every half hour of racing. More is better and topping off the coolers is recommended
- Pack water and fresh mix in the cooler for the team car. Include some mini Cokes and Fantas, some sparkling water for director and mechanic, and any other goodies they request
- Rotate the previous day’s mix from the car cooler to the van cooler and put it on the top row to go on the bikes and in musettes first. Put fresh mix as needed on the bottom row.
- Dump mix after day 2; it’s no longer good
- Pack mini soda in the gaps and include a bottle of ice if necessary
- Make sure the van is stocked with water, empty clean bottles, chocolate milk, and plenty of mix for hydration, preload, and recovery mixes
- Mark mix with an X and recovery with an R
- Bring a large bag of clean empty bottles to fill during the race
- Fill empty 1.5 L bottle with tap water and put in the freezer to use for ice
- Pack gels and bars in the team car as per director preference. Some use a box, others just stuff them in the door pockets
- Clean and stock the van
- Vacuum and sweep floors, wheel wells, bike area, etc
- Wash the exterior and Windex on mirrors and windows (this can also be done the night before)
- Program start parking into the GPS
- Pack the following race items in the main compartment:
- Towels and washcloths for each rider plus spares
- Podium bag with bottle for recovery
- Race food — bars and gels
- Spare clothing bag
- Supply box with chamois cream, massage creams and oils, baby wipes, sports wash, embrocation, sunscreen
- Medical box
- Finish cooler bag with bottled water and Fanta for each rider
- Spare musettes
- Food box of snacks, coffee, race rice, tuna, bowls, utensils, condiments, etc
- Folding chairs for each rider
- Wind vest for the feed zone
- 2 helmets (small and medium) in the van, 2 in the team car
- Pack in the bike compartment:
- Trash bags
- Spare bottles
- Aluminum foil
- Mixes and hydration supplies
- Extra water
- Extra soda and juice
- Milk/soy milk/whatever they want for recovery that day
- Black and white permanent markers
At the start
- Drive riders to the race start and park so as to make a nice area for them
- Put out folding chairs (under the awning, if necessary)
- Put out cooler, race food, regular food box, supply box
- Offer pre-load and put 2 bottles on each bike of whatever the riders want to start
- Massage legs/apply embrocation as needed
- Program feed zone location into the GPS
- If time permits, go to start line with riders to top off bottles and take extra clothing
- Drive to the feed zone
- Stop for gas on the way if necessary and time permits
- Find a good, visible parking place near the end of the feed zone
- Program the finish line into the GPS
- Prepare musettes for each rider
- 1 bottle each of water and mix on opposite sides
- 1 bar
- 1 gel
- 1 bit of cake or Nutella sandwich in aluminum foil
- Tie a knot at the top of the strap
- Prepare recovery, mark bottles, and place in the cooler
- Prepare 1-2 dishes of post-race rice for riders taking the team car instead of the van
- Fill bottles for the next day if needed
- Pass musettes to riders on the right side of the road
- Step into the road no more than 1 meter and face riders fully. Hold the tab straight up so it presents the bag at hand-level to the rider. Let go quickly and gently
- Pass any extras to the team car
- Jump in and proceed to the finish location post haste
At the finish
- Park the van near the finish line in a good location for getting out after the race
- Prepare an area for the riders
- Folding chairs out for each rider
- Bottle of recovery, towel, and washcloth on each chair
- If in a safe location, put out food box and supply box
- Riders bags out if someone is there to watch it, otherwise locked in the van
- Program hotel address into the GPS
- If there are multiple circuits, take a musette with bottles to feed
- If no circuits (or time doesn’t permit), also take the finish bag and podium bag with a bottle of recovery inside
- Set up at a visible location well past the finish line and flag down riders. Give water and Fanta, give directions to the van, and give the first rider the key
- Check anti-doping at the finish line, and take a picture of it if possible
- Head back to the van, do first aid if needed, and pack everything up
- Give post-race recovery food to the director for riders going in the team car
- Put dirty bottles in a bag or another cooler. Throw away bottles used for recovery; they will always have a weird funky sour milk smell
- Pack everything up and head out
At the hotel
- Unload and tidy up the van while riders are getting showered
- Put perishables in the refrigerator
- Start a load of riders’ laundry
- Set up massage table and supplies, overturning furniture or using a hallway if necessary. Try to get linens and towels from the hotel, if not use stock and wash daily
- Massages for all riders, ~30 minutes each
- Put riders’ laundry in the dryer or on drying racks
- Go eat dinner
- Leave dry clothes in the hall with bottled water for the riders
- Wash van and team car if weather/time permits
- Wash dirty bottles if needed
- Go for a run or straight to bed. Or beer, this is a good time for beer too.
So that’s it, in a nutshell. In addition, hotel transfers require all kinds of tedious minutiae, like getting room keys and wifi passwords, so those responsibilities are added in with a bare-bones staff.
Murphy’s Law hung like a shadowy specter nearby all week — if something could go wrong, it invariably did. One rider crashed in the last few kilometers of the first stage, a face-first header that left him bloodied and concussed, forcing him to withdraw from the competition. Another rider succumbed to a nasty illness during stage 4 and abandoned the race. On stage 5 I had a fender-bender with the team van when another car tried to pass and cut me off in a one-lane roundabout, and the French police refused to help with the paperwork so I did the best I could with the chasm of language barrier. I fumbled musette feeds and completely forgot to check anti-doping on one stage, delaying the whole team’s departure from the finish site. The sky poured rain and blew gale force winds and baked the slimy, muddy roads and cobbles with searing sunlight. I chastised entitled French sports fans trying to steal bottles right out of my musette for circuit feeds (seriously, guys?). I forced back tears on more than one occasion and struggled with the language barrier and shame over my beginner’s pitfalls with Robert, and his frustration with having to take the time to train a novice when time itself is at a premium. It had its tense and terrible moments, and I found myself wondering what I had gotten myself into frequently.
But it also had its moments of beauty and levity; I made it through the week, and I came back to Sittard visibly changed: more confidence in my abilities, more relaxed around the riders and other staff, with better strategies to ask the right questions and keep track of the answers, and a wealth of notable information in my brain and in detailed notes on my iPad. Serving as an apprentice soigneur helped me understand the structure of an elite cycling race and with the basics established, I can focus more of my attention on helping the riders and the other team staff to have a great race.
Bretagne feels like a distant memory now that I’m packing up and preparing to head to the Czech Republic for the Course de la Paix (“Peace Race”) the day after tomorrow. I’ve graduated from second-string soigneur to having my very own program in my charge: the USA national juniors team, a group of six outstanding 17-18 year old racers, some of whom are on their very first trip to Europe. I’m starting to get beyond my new-job anxiety and excited about what I can teach them and learn from them. Putting oneself wholly in the service of others is a humbling and enriching experience. As tough a job as this is, it really is an honor to be a part of the journey for riders on their way to achieving great things.
Tomorrow we make all the necessary preparations to depart, and adventure again awaits. More dispatches from the East to follow!
It’s quickly approaching that time of year again — the 2 weeks or so where gyms are inundated, diet books fly off the shelves, and Americans once again resolve to better ourselves in the New Year. According to a Time Magazine article this week, the most common resolution will be weight loss and improved fitness. Year after year we fall into the same pattern; some of us succeed in lasting lifestyle changes, but the vast majority will quickly fall back into old habits. What can we do to break the cycle?
Last year at this time, I was still in graduate school and despite the fact that I was devoting myself to the scientific study of sports medicine, I was not practicing healthy lifestyle habits. I wasn’t making time for exercise and my eating was frankly atrocious. I had gained some weight and lost a tremendous amount of fitness, and I felt terrible. I had to change.
Today, I’ve lost 45 pounds and 6 inches off my waist from one year ago. I’m keeping up on very fast group bike rides and I’m running better than I ever have in my life. These changes haven’t happened overnight, but they have been consistent and lasting; I’d like to share some of my success with you in hopes that you can find it helpful in your lifestyle as well.
- Accountability. I’ve always done better when I had to be accountable to someone other than myself, whether it’s a dietitian looking at my food intake logs, a personal trainer giving me instructions on exactly what exercise to do, or a coach’s training plan. I knew that while I was taking an overload of graduate classes and working 2 jobs, the most important factor was going to be adherence to a healthy, calorie-negative diet. I used an app called My Fitness Pal to keep careful records of overall caloric intake as well as the breakdown in macronutrient percentages (carbs, fat, protein). The app certainly has its limitations, but it’s free, the mobile interface is user-friendly, and the food library is very complete. Having a bold number on a page really helped me to focus and think about selecting foods that would meet my nutrition goals, instead of eating without thought of effect.
- Food as Fuel; Exercise as a Privilege. This one was all about mindset for me. I had often fallen into the trap of punishing myself for eating badly with a really hard workout; completely unconsciously, I had begun to regard exercise as a one more onerous responsibility instead of a stress-busting, fun, healthy activity. I started planning my food intake around the workout I wanted to do that day, and I tried to make them as fun as possible. Going to the gym with my significant other was great incentive, with the added bonus that we tend to push one another to work harder. Mountain biking with my dog is one of my favorite things — I get a really fun ride with my best friend, and I got the dog good and tired so she wouldn’t bug me (as much) when I really needed to buckle down to work and study. I always felt better after a workout, and thinking of it in terms of an enjoyable activity instead of a means to offset other unhealthy choices removed a huge mental obstacle.
- Flatten the Playing Field. One of the classes I took last spring was a Health Policy class in the Department of Public Health. The professor explained public health initiatives through the metaphor of the myth of Sisyphus, the ancient Greek king who was condemned to roll a boulder up a steep hill only to watch it roll back down for eternity. With any health challenge we face, the steepness of the hill is determined by the factors that make success more difficult. As an example, consider quitting smoking. The factors that make it more difficult might include pressure from peers who are also smokers, life stress that is alleviated by smoking, fear of weight gain after quitting, physiological addiction to cigarettes, and even lack of insurance coverage for cessation treatments. Removing or reducing those factors makes the slope less steep — getting on a new insurance plan, joining a group to provide social support for quitting, taking up leisure activities that promote health and reduce stress. Furthermore, one can factor in advantages to quitting — reduced cost of insurance, improved health, eliminating potential harm to friends and family, and so on — that raise the bottom of the slope, leveling it out even more. Suddenly, pushing the boulder uphill isn’t daunting. The same was true for me with weight management — I needed to make good choices easier, and unhealthy choices less desirable. I committed to not buying any food that was inconsistent with my health goals to remove the temptation of having it in the house, and I cleaned out my cupboards and donated the offending food products I already had to a food bank. I started trading out sports massage services for personal training with a gym and scheduled my workouts during gaps between classes to make it as easy as possible to stick to my schedule. I even bought some particularly cool-looking running shoes; don’t underestimate the power of adding some fun to a workout! Making the right choices easier helped that boulder keep on rolling without much added effort on my part.
- Make SMART goals. SMART is an acronym used in athletic training and physical therapy rehabilitation; it stands for Specific, Measure, Assignable, Realistic, and Time-Oriented. I found these criteria really helpful in goal-setting for healthy lifestyle choices too. Vague goals (“I want to lose weight”) are hard to conceptualize and rarely succeed. Instead, I reviewed a lot of health literature and talked to experts to determine an appropriate and attainable specific weight goal for myself. I keep track of a lot of measurements to track my progress, including weight, hip, waist, and neck circumference, resting heart rate, and sleep patterns. My gym also has a station that takes more medically-oriented measurements, so I track blood pressure and body fat percentage using that equipment. Those measurements help me assess progress and adjust my practices to keep on track; I don’t think that keeping track of measurements to that degree of detail is right for everyone, but I’m a numbers-oriented person and it’s been really helpful for me. “Assignable” refers more to a rehab setting where a patient works with a variety of people, but I use that criteria to assign myself fitness tasks each week (for instance, this week’s job is a long bike ride on Tuesday). Realistic goals are crucial to success, so I shoot for a pound of weight loss per week. This makes it much easier to stay on track and such gradual progress is much more likely to be lasting progress. I make my goals time-oriented by setting fitness benchmarks, such as entering races or events and just having dates where I want to have achieved specific aims (usually these are regular doctor check-ups; I like showing off how to my doc how well I’m doing!).
- Be Realistic about Setbacks and Successes. I would be a big liar if I didn’t admit to falling off the wagon now and then. Sometimes it has been out of my control — I recently had to take a 10-day hiatus from exercise after a medical procedure — but most of the time I can point the finger to none other than yours truly. Too often, setbacks have snowball effects that result in a catastrophic tumble; we see this all the time with crash dieters whose resolve wavers and they end up gaining back even more weight than they lost. Willpower is not an inexhaustible commodity, so it’s important to identify potential pitfalls and offset their impact. For most people, getting it right 90% of the time is enough to see progress. For me, that means about 1 meal per week that’s less than stellar. I don’t go overboard, but I also try not to have such hard and fast food rules that a taste of forbidden cookie will send me spiraling in an out-of-control tailspin. Take it one day at at time; one bad meal isn’t going to demolish all your results, but neither is one good one sufficient for success — it’s all about consistency. Instead of totally cutting out an unhealthy habit, reduce it a little with an alternative; I can’t live without chocolate, so I started buying small quantities of extremely high quality dark chocolate and keeping it in the freezer, so it required a lot of work to break a little piece off, let it thaw, and savor it, instead of demolishing a whole candy bar. Little steps in the right direction are more powerful than trying to make giant leaps that may backfire into setbacks.
- Surround Yourself With Experts. Every big organization, school, or corporate entity has a board of directors to provide the best decision-making insight to the leadership. Establish your own personal board of directors to inform your lifestyle decision-making; I got this advice from a very wise high school principal, and it has proved to be an extraordinary tool for all kinds of big choices. In my journey to better health and fitness, I have sought out the company of experts with specific knowledge to fill in the gaps of the big picture. I had a bit of trial and error in assembling my board of directors — one mistake I made was wanting to get better at running, so I asked a well-meaning runner friend where I should start. “It’s easy!” she exclaimed. “Come out on a run with me and I’ll show you!” And thus ensued a horrible experience of being dragged around a totally inappropriate course at way too fast of a pace until I felt like I would never be able to take a full breath or keep food down again; it was really defeating and would have been very easy to give up right then and there. But instead I consulted a running coach who helped me to streamline my form for greater stride efficiency and ease. Similarly, I asked my friend Tommy Rodgers, a dietitian and local cycling legend, for some nutrition tips that helped me come away with a much better understanding of fueling my body. I also started getting regular massage therapy, which proved to be a huge boon — it helps me recover from hard activity much faster to optimize my training, and it’s a wonderful calorie-free reward for good lifestyle choices. Here’s a plug for my employer: at E3: Elite Human Performance, we have all of these services under one roof; it’s a superb resource no matter where you are in your fitness journey.
- Budget for Expenses. Healthy eating habits and exercise do incur some unique financial expenses, but look at it this way — have you priced type 2 diabetes recently? How about treatment for the dozens of cancers that have been directly linked to excessive body fat, or cardiopulmonary diseases? A little extra expense and careful spending now can add years to your life; it’s impossible to put a price on that. Fitness and healthy lifestyle don’t have to be all Whole Foods and exorbitant gym memberships; you can accomplish strength training at home with equipment you already have, join a free running club where all you need is a decent pair of shoes, and buying fresh produce instead of pre-packaged options can actually save a lot while optimizing nutrition. Investing in a training plan from a coach and other fitness-related services in the short term can help you build lasting habits, and you will reap benefits in physical health, self-confidence, and healthy habits for life. You don’t have to think of these commitments as long-term and continuous, but it’s great to try a variety of things and see what works best. I have been most successful with picking competitive events in which I want to participate and getting training plans built around the event schedule to keep myself on track. It incurs financial burdens, but the benefits of deeply enjoyable activities, friendships I have built through sports participation, and how great I feel when I’m eating and training well is more than worth the expense.
I want to wish you the best of luck on your New Year’s resolutions, whatever they may be. Remember too that any type of change is about the process, not the end point of the journey. Making that process deliberate, minimizing the obstacles in your way, and enjoying the voyage of reaching toward your goals will help you succeed. I’m well on my way to health for life, and I keep being surprised by unforeseen benefits I encounter. Keep your mind open to new possibilities along the journey; a year ago, I never could have guessed there was a runner inside me waiting to be let out!
What are you resolving to do this year? Tell me about it in the comments!