What to Eat on Test Day?:
By: Dr. Jen Milus, DC www.fireagility.com

Let’s start with the 3 days before the big test! Eating right on test day is not near enough! If you want to test well… remember that garbage in means garbage out! If you eat junk, you’ll perfrom just that way! You need to start carb loading and hydrating 3 days before the big day!

Portions:
For the purposes of this article, a serving of a protein, fruit or vegetable is the size of one’s fist.

Protein:
By this I mean pure protein: fish, eggs (remove yolk), turkey, chicken, pork or lean beef. Peanut Butter does not count.

Fats:
During this time, limit your fats to what is inherent to your food. Eat no fried food until your test is over. You may eat a pat of butter on your whole wheat toast, BUT: eat no hydrogenated fat- not margarine, peanut butter*, crackers or cookies that have even “partially hydrogenated” oils in them. These types of fats sit like sludge in your veins. They slow you down and impair your oxygen carrying capacity. This means you will be slower, and get out of breath more than you would have otherwise.

*Peanut butter is one of the biggest sources of hydrogenated fats in the American diet. Most of it is just lard with peanut flavor! The only kind you should ever eat is the Laura Scudder’s type; just smashed peanuts and salt. If you only like the other kind, then give it up altogether!

Raw Nuts:
I repeat RAW nuts. I good mix of raw nuts (even in a trail mix) is easy to find at Trader Joe’s! Bring a big zip lock bag in your bag to the tournament! Great for snacking! Eat only a handful at a time… at most, 2 handfuls/hour.

Sugar and White flour:
Both of these are short chain carbohydrates/simple carbs. They result in quick energy, and a slow of energy afterwards as your blood sugar plummets. Eat whole wheat pasta, bread, avoid sugar during this time. No white bread.

Processed Food:
I have not found much processed food that was not chock full of hydrogenated fat, white flour and sugar. So stay away from it. Eat whole foods. Real food, as straight from the earth as you can.

*Peanut butter is one of the biggest sources of hydrogenated fats in the American diet. Most of it is just lard with peanut flavor! The only kind you should ever eat is the Laura Scudder’s type; just smashed peanuts and salt. If you only like the other kind, then give it up altogether!

Day – 3

• 3 servings of protein: one at each meal.
• 3-4> servings of fruit: eat at meals or snacks.
• 3-4 servings of vegetables today. Try to eat them raw, but you can slightly cook your veggies.
• Salt your food, but not heavily.
• Eat Whole wheat products if you are eating them, and eat brown rice instead of white.
• 6 glasses of water today.

Day – 2

• 3 servings of protein: one at each meal.
• 3-4 servings of fruit: eat at meals or snacks.
• 3-4 servings of vegetables today. Try to eat them raw, but you can slightly cook your veggies.
• Eat a large salad with dinner.
• Salt your food, but not heavily.
• Eat Whole wheat products if you are eating them, and eat brown rice instead of white.
• 6 glasses of water today.

Day – 1 this is the day before test day.

• 3 servings of protein: one at each meal.
• 3-4 servings of fruit: eat at meals or snacks.
• 3-4 servings of vegetables today. Try to eat them raw, but you can slightly cook your veggies.
• Eat a large salad with dinner, and pasta or brown rice.
• Salt your food, but not heavily.
• Eat Whole wheat products if you are eating them, and eat brown rice instead of white.
• 6 glasses of water today.

Morning of:

• Wake up at least 2 hours before your test.
• Drink something warm so you can go to the bathroom (#2) before you leave the house. This will help you feel lighter and be faster on your feet.
• I drink a cup of coffee or 2 because it helps mobilize free fatty acids, this turning up your fat burning machine, and reducing the glycogen used… you’ll need all you can get!
• Eat 2-5 eggs… I remove all the whites but one. This will depend on your size!
• Drink a cup of juice
• Eat Oatmeal or 2 pieces of whole wheat toast (one pat of butter only)
• Bring a piece of fruit for a snack in you have to wait, plus some raw nuts. OR:
  2- 3 energy bars- ones with protein in them… balance bars or such.
• Drink water this morning!!!

Lunch/Test day: if you test in the afternoon…

• Nothing fried, No hotdogs. Eat a sandwich and a piece of fruit.
• Water!!!!!!

If you have any questions at ALL about what you should be or not be eating, do NOT hesitate to ask. Just be ready for the answer. You might not hear what you were hoping for!!!

Dr. Jen Milus, DC
www.backsafegolf.com
www.fireagility.com

Knees! Knees! Knees!
Strength Training and Injury Prevention in One!
By Dr. Jen Milus, DC

Problem:

I am looking for an alternative training that will protect my knees. What do you think, Dr. Jen?

Answer:

Protecting your knees is a problem. I would make sure you get cleared by your doctor. If you have any concerns or previous injuries involving that joint- or any other, for that matter, make sure they do a full orthopedic exam and that all of your joint tissues are integrous before you start training.

Then I would allow an extra month or so to get it strong before you do other weight training. Then, once you have completed this knee strengthening program, I would work it in a time or 2 a week with your regular work schedule!

This will be based in interval training, resistance, and perceived exertion. Intervals will use one major muscle group, and then another, or do it in another way, and start with the first again. They will be in time or numbers of repetitions. Perceived exertion level will be rated on a scale from 1-10. 1 is barely noticeable, and 10 is so difficult, that “I could only do it for 60 seconds before my heart or my legs gave out!”. You control your perceived exertion level by increasing tension on the bike. You would have to use the tension knob on a spinning bike or the manual mode for a regular stationary bike. Make sure your seat is high. Stop if your knees hurt, and you may stand up during your riding if it feels better. You will move from one interval to the next without stopping or resting. Remember that there is no law that says you have to start right off doing this complete workout. If you become too tired, stop, and try again in a few days! You might have to go to the gym at a slow time so no one steals your bike during your other intervals!

Set 1:
Interval 1: 3 minutes on stationary bike, perceived exertion level 2/10.
Interval 2: 10 pulls ups.
Interval 3:  10 walking lunges. Make sure your form is safe. Never allow your forward knee to go in front of your ankle. Put the weight of that forward foot into your heel, and never allow it to translate into your toes. Take a big step, land weight in forward heel, and lower straight down until your back knee almost touches the ground. Keep your trunk tight, and straight up! Hands on hips.

Set 2:
Interval 1: 1 minute on stationary bike, perceived exertion level 3/10.
Interval 2: 12 pulls ups, or failure.
Interval 3:  12 walking lunges.

Set 3:
Interval 1: 1 minute on stationary bike, perceived exertion level 4/10.
Interval 2: 14 pulls ups, or failure.
Interval 3:  14 walking lunges.

Set 4:
Interval 1: 1 minute on stationary bike, perceived exertion level 5/10.
Interval 2: 16 pulls ups, or failure.
Interval 3:  16 walking lunges.

Set 5:
Interval 1: 1 minute on stationary bike, perceived exertion level 6/10.
Interval 2: 18 pulls ups, or failure.
Interval 3:  18 walking lunges.

Set 6:
Interval 1: 1 minute on stationary bike, perceived exertion level 7/10.
Interval 2: 20 pulls ups, or failure.
Interval 3:  20 walking lunges.

After your first week, add:

Set 7:
Interval 1: 1 minute on stationary bike, perceived exertion level 8/10.
Interval 2: 20 pulls ups, or failure.
Interval 3:  20 walking lunges.

After your second week, ad:

Set 8:
Interval 1: 1 minute on stationary bike, perceived exertion level 9/10.
Interval 2: 20 pulls ups, or failure.
Interval 3:  20 walking lunges.

After your 3rd week, add:

Set 9:
Interval 1: 1 minute on stationary bike, perceived exertion level 10/10.
Interval 2: 20 pulls ups, or failure.
Interval 3:  20 walking lunges.

After your fourth week, add:

Leg extensions in the last 15 degrees of extension.
This works the medial quad.
Go from barely bent to slightly straight and back again. Don’t force it into hyperextension!
Start with a relatively light weight, and only ever progress to a medium-light weight!
Start with 2 sets, 1 minutes rest between.
You can work up to 6 sets, with 1 minutes rest between.

Hamstring Curls:
This creates balance in the knee that you simply cannot do without!
Start with 3 sets, and work up to 6. Start with a light weight, and progress up.
Your hams are only 60-70% as strong as your quads. Keep that in mind.
Also, remember to do even number of sets between the 2 muscle groups.
For example: if you do 3 sets of leg extensions in the last 15% of extension, and you get self willed, and add 3 sets of normal full range leg extensions, do 6 sets on hamstring curls!

Supplements:
Glucoseamine Sulfate (Not Glucoseamine HCL) in the amount of 1200-1500 mg/day. It will make a huge difference in soft tissue/ligament and tendon repair! Prevent injury and arthritis! Make sure you get it from a reputable source!

Always remember to stretch!

You can read more on training and injury prevention on my web sight!

Dr. Jen Milus, DC
www.fireagility.com

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Low Back Pain

By Dr. Jen Milus, DC

Low Back pain is among the most debilitating injuries in the American workforce today. Firefighters are NOT immune. But what can we do ourselves?

There is no magic bean for mechanical low back pain. There are a variety of choices for care for your back pain: Chiropractic, massage, acupuncture, Physical therapy, pain killers and muscle relaxants. Whatever your choice: Your healthcare provider cannot help you nearly as much as you can help yourself. Any treatment they do really needs to be additive to what you do yourself.

Acute Low Back Pain:

Pain is often rated on a pain scale of 1-10: 1 is barely noticeable, and 10 is so bad that one is unable to move or function. The initial, extreme pain that gets people to their doctor is called the acute or inflammatory stage. Most people rate that as 7, 8, or 9 out of 10. It can be marked by localized swelling, and heat in the immediate area. Some doctors prescribe anti-inflammatory medication for that. I prefer rest, a few exercises, and ice- in that order.

The chemical bi-products of inflammation actually soften the tissues in the area. This leaves those tissues more vulnerable to tearing and long term injury. Taking soft tissues to end range by bending, lifting, and twisting can be especially damaging. So- don’t push things during that time. Rest is important at this time. The objective is to break the inflammatory process, re-create flexibility, and move on to strengthen and improve coordination. This will, if all goes well, lead to less painful episodes less often.

In this article, I will talk about ways you can do the first 2 steps: reduce inflammation and re-create flexibility. Of course, you should check with your doctor to make sure there is nothing that he/she needs to treat you for or with before you undertake self care.

The Rand Study (20+ years ago) proved that chiropractic adjustments work to reduce acute low back pain. This is certainly true in people who have an inflammation of the facet joints in that area. However, this can be a short lived quick fix. If the muscle spasm is not reduced, the motion restored, and the trunk strengthened around it, the bouts of low back pain will likely return. I am a big believer in deep tissue muscle work, manipulation or adjustment, and therapeutic exercise- all properly applied. They work… when used at the right stages in the healing process.

Let’s talk about what you can do on your own, though, as an adjunct, or at home to get yourself some relief. The 3 things I would have you do for acute low back pain are as follows:

See your doctor to rule out pathology. Then…

Get comfortable. This can be very difficult at this time. I find that people with low back pain often respond well to the 90-90 position. This is; hips and knees both bent to 90 degrees. Lay on your back near a sofa or ottoman. Your hips bent, and knees bent so your behind is “scooched” up close to the sofa. Your calves will be on the sofa. This will take the lordosis out of the low back and allow the facet joints a break from each other… take some of the pressure off the area.
This is a great position as it is easy on your low back and you can slide an ice pack under your low back as well.

Ice: Ice is a great tool for reducing and breaking the inflammatory process. It will also slow the pain nerve’s transmission signal to the brain by up to 60 meters per second for up to 12 hours. It needs to be used repeatedly, and quite often for a few days when you really hurt. Try to ice every 4 hours for the first 2-3 days of your flare up. (I know- that’s a lot to ask, but, it works.)

Remember that the inflammatory process is like a camp fire. You might think it’s been put out, but if you don’t go back and stomp on it several times, and dump more buckets of water on it, it might just smolder for a few days and come back full bore and put you right back where you started.

The icing is great. Wait a few hours after the ice. Then do a few exercises and ice again. Wait a few hours, do the exercises and ice again, etc.

The exercises I recommend for acute low back pain are:

            Pillow Pelvic tilts: 20 reps
In the 90-90 position, put a pillow between your knees.  Suck in your stomach and hold. Squeeze the pillow and hold. Now do a pelvic tilt and press your low back down onto the floor and hold everything for 5 seconds. Do this 20 times. When you are able to move, go on to the next exercise.
            Cat and Dog: 10-20 reps
Get on your hands and knees, hands and knees shoulder width apart. Suck in your stomach. Do a pelvic tilt. Slowly push your low back up toward the ceiling. Hold for 5 seconds. Relax, let your low back arch as low as is comfortable. Let your shoulder blades sink together, and lift your chin slightly. Hold for 5 seconds. Slowly take it back up. Repeat 10-20 times.
            Knees to chest, roll in circles 10-20 reps each way
Lay on your back. Bring your knees into your chest. Now roll the knees in a circle as if you had a pencil between your knees and were drawing a circle on the ceiling. Go 10 each direction. Increase each time until you hit 20 each way.
            Drop knees to each side, 1 minute each way
Drop the knees on the floor next to you, knees and hips bent to 90 degrees. The outside of your bottom leg will be in the floor. The other leg will be right on top. Reach the upper body the other way. You should feel a comfortable rotation in the entire lumbar region. Relax 1 minute each way.

You may follow with icing for exactly 20 minutes in the 90-90 position.

Here is how you make the ice bag:

Put about 20+ ice cubes in a freezer zip lock bag
            Cover the cubes with water
            Squeeze out the excess air
            Zip it shut

Place directly on your low back.

Heat:

When your pain has reduced to 2-3/10, you can use Ice and heat together.
Use a hot shower, hot bath or hot tub with jets. Let the hot water contact the area for 10 minutes. Then, follow with these exercises:

Do each of the above exercises, Plus:
           
Standing Lateral Flexions:
Stand with your feet twice hip width apart. Slide your left hand down the outside of your left leg to support the weight of your trunk. Take the Right hand and reach up and over your head, and lean left. Slide the left hand down, and feel the stretch in the right side of your low back. Lean slowly over, and hold for 15-30 seconds. Now go the other way.

Follow with 20 minutes of ice- again, at 90-90.
This routine of heat-stretch-ice is great for pumping inflammation out of the area, relaxing spasm, and getting new healing nutrients into the area.

Things NOT to do During this time:

            Unanswered heat:
Do not put unanswered heat on the area. The heat brings in excess blood and does not pump it back out again. It might feel good temporarily, but it can worsen an inflammatory process… make it linger.  Always follow it with a stretch and ICE. The heat stretch ice thing really does works!
           
            Ice Before Exercise:
Ice has it’s uses. But remember that it shortens, tightens and stiffens the tissues in the area. Do not ice before you exercise. Do it afterwards.
           
            Motions that are hard on your inflamed disc/ligaments/joint tissues:
Unsupported forward flexion, Lifting heavy objects, and twisting are all tough on your low back. Don’t lift things that are a far reach away from you; keep them close to your body.

I see people in the gym doing these things:

            Rotations with weighted Bar on shoulders:
Axial loading of the spine plus rotation is damaging to the disc and joint tissue. Besides, this really doesn’t strengthen you at all in any productive way.

            This Exercise is even worse:
Axial Load, Plus rotation, plus forward flexion is extremely compromising to your low back.
           
            Stiff Legged Dead lefts done improperly:
Remember to keep your chin up, and your low back completely flat during this exercise. If the low back bends at all, you are already injuring yourself.

            Yoga Cobra Stretch:
This is the one where your pelvis and legs are on the floor, and you press your trunk up and (hyper) extend your low back. This jams your facet joints together, and can single handedly cause a facet syndrome, and set of an episode of low back pain.  Some people think this is a good stretch… for some it is, but most it’s not. There are (somewhat different) extension exercises that work well in a therapeutic setting- like McKenzie exercises. However, they need to be applied by a Physical Therapist (or an exercised inclined Chiropractor) who has been trained in the technique.

Later, when lifting heavy objects:

            Bend at the knees and hips
            Keep your abs and gluts tight, and back flat!
Keep the heavy object close to your body
If you need to rotate, do so with your feet, entire body, not from the trunk

Be healthy. Be safe, and read next month about Trunk Stabilization.

• If you have low back pain, use this month to do the things above. Then by next month you’ll be ready for the next step.
• If you already feel great, and want to look great, we’ll talk about exercises to prevent injury, and give you great abs and obliques!

Dr. Jen Milus, DC
www.fireagility.com

Step Mill Training for the CPAT
By Dr. Jen Milus, Author of Fire it Up!
www.fireagility.com

No matter how hard you train for the stair climb, your legs will feel like rubber when you're through. The time it takes to recover from this depends on your fitness level and your V02 Max. VO2 Max is the maximum amount of oxygen your body can process in order to feed your muscles to do work. In tests like the CPAT, if your VO2 Max is not high enough, you simply fail. Your legs may give out, or worse, you may become injured.

To avoid these pitfalls, you must train properly!

Gradually pushing up your limits over time can allow your body to compensate a little bit each time. This allows your heart and lungs to get stronger each time, thus preparing you for more, harder work the next time.

This is an event that is really easy to train for. You simply need a road-map of how much weight to use when, and a plan of how to safely increase resistance and duration. You really do need a weight vest for this. They are sold at weightvest.com.

Remember that training on the step mill is only part of the training process necessary for training for the CPat. Your legs need to be trained with medium to heavy weights. This step mill training plan is only a very small part of the bigger picture. If all you do for your legs is this training plan, you will probably fail the CPat.

Warning! Many people train with a back pack full of sand, or by carrying a weight plate. Don't do this! It changes the biomechanics, and puts your spine at risk! It causes small amounts of injury each time you do it. This adds up, and will cause you problems in the future. As you age, you are much more likely to hurt your back. These sorts of injury are often career changing, if not career ending! Use a weight vest!

Another Warning! See your physician before beginning any exercise program! If at any time, you feel dizzy, sick, or sore for more than 48 hours in one particular area, stop doing the offending exercise! Ask your doctor’s opinion! Remember that no everyone’s body is intended for these uses!

Watch your Achilles tendons!

Make sure when you step up onto that next step each time, that your feet hit the step in this order: heel-ball-toe, then push-off. Do not do this training on the balls of your feet, or with your heels hanging of the stairs as you step. This will lead to injury of your Achilles tendon(s).

Special Cases: Big feet or no Step Mill

Remember, there are cases when some people cannot train on a step mill, but must use something to simulate it. These limitations might be: your feet are too big for the mill’s steps or lack of equipment.

In either case, I recommend a step used for aerobics or a stair at home. The step should be should be 8-9 inches high. This means you will have to step up, up, then back down off the back: down, down. Get your whole foot on the step (or on the floor) with each up and down. No heels should hang off. Going up, it will go heel-ball-toe and coming down it will go toe-ball-heel.  Change your lead leg each 30 seconds of step training to avoid Achilles stress. Remember, you would count an up-up, then down-down, as one step. You must do 60 of those per minute.

Tall Buildings:

I do not recommend using a tall building unless it’s tall enough to keep walking steadily up stairs for 6 minutes without stopping. In other words, don’t choose a place where you have to walk up 2 flights, then walk back down again before you can walk back up. This will do 2 things: 1. it will give your heart rate a chance to slow, thus not training you well. 2. Walking down stairs is not good for your knees. Even if they are young and healthy, why do it? Especially training? You should save those knees for coming down the stairs of a burning building once you have a job- with a person in your arms!

Step Depth and foot size on test day:

If your feet are too large for the step mill used in the test, that’s a tough one. You should still not train on the step mill. Use the up and back down off the back method mentioned above. Two days a week after your step training, do some calf raises: start off with 2 sets and work up to 5 sets of 8. Stretch the calf, and the Achilles tendon. That is, do a calf stretch with your knee locked for 30 seconds, then with it slightly bent, foot still flat to the floor for 30 more seconds. This should prep your calves for the actual test without hurting you.

So what’s the Plan?

Here’s a plan for you to use. It will take you 11 (plus) weeks to get through it. Train a day on the step mill, and lift weights with your upper body on other indicated days. One thing I would avoid, though, is weight training for your traps specifically during this time. So: don’t do shrugs or upright rows. The weight vest is tough enough on them. I say strongly: some people might also like to lift with their legs stepping days, but it’s too much to cover here.

This workout is longer than you will be required to do for the step mill on test day. This will make test day easier, plus make you more than ready for the additional demands of test day! For more information on what is expected on test day, read here: www.fireagility.com

Make sure you warm up 5 minutes easy on the stationary bike, and stretch after wards- especially your calves!

From here forward, you should be able to be step mill ready if you do the last workout twice a week!

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Firehouse Butt-Kickin’ Circuit Training
By Dr. Jen Milus, DC www.fireagility.com

If you only have an hour to train, and want a really intense workout, try circuit training. The key to great circuit training is to use only major muscle groups. Each exercise must use many joints at one time. One must move exercise to exercise rapidly to force the body to move blood from one area of the body to another quickly. This increases the heart rate, increases metabolism, and intensifies the after burn. Note: This does not mean that you do the actual exercise quickly, just that you move between them quickly. Don’t waste a lot of time writing notes either!

Warm up before you do this workout, and always stretch afterwards. WARNING: Exercise at your own risk! This workout is intense and not intended for beginners. It uses only 7 different exercises. Move from one right to the other, without resting if possible. Go the 1st through the 7th exercises as many times as you can until either you are spent or your hour’s up! Do NOT do this workout more than once or maybe twice a week. Keep cross training!

Read through the exercises below. Be sure you understand the instructions given. If you do not, please write to: drjen@backsafegolf.com and ask for clarification. Print out the chart on the final page. Go to the gym when it is not busy, and there is plenty of access to equipment. That way no one will steal your “toys” when you are off doing another exercise!

Bicycle abs:

Always do these on a bench as shown here. Rotate and lift the upper body to touch the elbow to the opposite knee, and hold for 3-second count. Exhale as you touch the elbow to the knee, and inhale as you cross the center to go to the other side. The other elbow should be below the level of the bench, allowing for maximum rotation. You will start with 25, and work up to 100.

Close Grip Lat pulls:

Hold the handle in your hands, and lean back to almost 45 degrees from straight up. Contract your abs and hold them tight. Let the shoulders roll all the way up next to your ears, then pull down to the bottom and squeeze the shoulder blades together in back. Inhale as you let the hands up slowly, and exhale as you bring the handle down to touch your upper chest. Hold at the chest for a count of 3. Do this exercise with ½ your body weight the first exercise, and do 20 reps. Thereafter, during this workout, increase your weight by 10 lbs each time, and still try to do 20 reps. If you would rather do one hand-rope pulls, by all means, look here: CPAT Events

Ball Push-ups:

Put your knees on the ball as shown here, abs tight, hands in a wide grip position. Inhale as you lower to touch your nose to the floor. Exhale as you press up. Keep your abs tight and your body like a plank the entire time. Do 20 reps the first set, and go to failure there after during this workout. For more information  on working your pecs, and saving your shoulders, see regarding bench press… here: FAQs

 

Decline Leg Press:

Put the Leg press seat back as far up as possible. Sit in the machine with your butt and low back pressed back against the bench. Walk your feet, on the foot plate, up so your toes hang an inch over the top of the foot plate. Press up and unlock the handles. Inhale as you lower the sled, to a 90 degree bend in the knee. Always press through your heels, and never hyper extend your knees. Start out with a 45 lb plate on each side and do a set of 20. There after, add a (25, 35 or 45) plate to each side each set and go down by 2 reps each set.  See how this exercise preps you fro your CPAT here: CPAT Events

Trunk Roll–ups:

Knees on the ball again, hands shoulder width apart. Roll up so your behind goes into the air. Go up to where you hips are bent at a 90 degree angle, and your shoe laces are what’s touching the ball. Do 10 reps the first set. Try to work up by 2’s each set as: 12, 14, 16, 18, 20. If you fail before you reach your number, that’s fine. This is hard! Keep your abs tight the entire time, and make sure you are plank-straight in the down position! If your low back starts to arch at all, you need to stop! You are at failure! You’ll be able to do more next time.  Caution: this is a difficult exercise! It is not intended for beginners! Anyone heart rate and respiration rate will increase on this exercise. Be careful! If you feel any grinding or pain in your shoulder socket, please stop this exercise and write to Dr. Jen for another idea: drjen@backsafegolf.com

Hamstring Curl:

Start with You legs straight, NOT hyper extended. Take a deep breath, and blow out as you raise the heels toward your butt. Inhale as you lower. Make sure you keep your pelvis down on the bench when you lift. This picture is actually incorrect; see how the pelvis is lifted? This is what not to do. Start with ½ your body weight, and do 20 reps. In each successive set, you will increase your weight by the smallest amount possible, and go to down by 2 reps each time.

Back Extensions on the ball: Lay on top of the ball, belly button at the highest point on the ball. Hands are behind your head. Feet in the corner where the wall meets the floor, toes out. Lightly squeeze the ball with your inner thighs, and take a deep breath. Lift up until your spine it totally straight, exhaling as you lift. Inhale as you lower. Do 20 reps this and every subsequent set this workout. To make this an even more complex exercise, add rotation to this one: www.backsafegolf.com

Best wishes in your journey!

Dr. Jen Milus, DC
www.fireagility.com
www.backsafegolf.com

Circuit Training By Dr. Jen   www.fireagility.com

Rotator Cuff Pain
Dr. Jennifer N. Milus, DC
www.fireagility.com and www.backsafegolf.com

Shoulder Pain:

Rotator cuff pain, sprains, and tendonitis appear quite often in athletes who require repetitive explosive movement of their shoulders. Fighting fires requires full range of motion of that ball and socket joint, and full function of the muscles around it. Pain on movement, or sharp pain on lifting can indicate that you have a problem with the rotator cuff muscles, and/or their tendons. If that is the case, then it would be a good idea for you to see an orthopedist or a very good Sports Med Doc and get it looked at. There can be minor sprains which can be worked with in the way described below, Or there can he more serious, full thickness tears that require surgery- and anything in the middle. If they okay it, then you can move on to these exercises. They may have other testing or studies they want you to undergo to rule out more serious problems.

Shoulder Joint Inflammation:

The shoulder is an encapsulated joint. Once an inflammatory  process starts inside the joint “capsule’, the process can be lengthy and painful. In addition to the pain, the mediators of inflammation actually chemically soften the ligaments, tendons and other joint tissues. Thus, activities that challenge those structures can cause more damage than the original injury did.

The supraspinatus, infraspinatus,  teres minor and subscapularis are often referred to as the SITS muscles. Each one of these muscles has one end outside of that capsule and one end inside the capsule. The end that is inside the capsule can become very irritated and painful. This pain is a signal that the tendons on the ends of these muscles, and the muscles themselves are more prone to injury at this time. Rest is a good idea at this point. Codman’s Arm exercises are indicated here, and your doctor should be able to show them to you. If he or she cannot, Please send me an e-mail drjen@backsafegolf.com

Because it is an encapsulated joint, the inflammation is tough to flush away. Icing is sometimes not effective (but definitely worth trying). Remember: 20 on, 20 off! Good, deep soft tissue work by an experienced Sports Massage Therapist, Physical Therapist or Chiropractor may help. Ultrasound with both of the above can help even more. Non-steroidal anti-inflammatory meds are often called on too soon, in my opinion. Try the other 3 first: ice, massage and ultrasound. I’d suggest you try Traumeel Ointment. Read more about it here: Traumeel Ointment. I recommend against Cortisone shots until everything short of surgery has been tried. It can lead to excess scar tissue formation.

Exercises to avoid:

I do a lot of sports injury rehab work, which entails a lot of shoulder injury work. When someone comes to me, and says they hurt their shoulder working out, I ask what their upper body workout consists of.

1. back flies or upright rows for posterior delts
2. Swimmer pulls with tricep push down pulley machine (straight armed) for teres/lats
3. dumbbell presses and pec flies in a safe range of motion for pecs
   Your shoulders will thank you.

I would also train very carefully with your shoulders in the future, matter who you are. Low back and shoulder injuries are common in Firefighters. Train the rotator cuff muscles specifically with light weight as a warm up on your chest and shoulder days at the gym. (The SITS muscles: supraspinatus, Infraspinatous, subscapularis, and teres minor). There are specific exercises for each. You should protect your future with just a few extra minutes each workout. Below, I will show those exercises!

Balance your workout:

For the most part, remember that people tend to train their push muscles more than their pull muscles. They over-train chest/pecs, and don't do as much lats/rhomboids. This leads to overly short muscles on the front, and internal rotation of the shoulder joint. Posture changes, to a forward lean... and palms face back when standing straight up. (The palms should face in). Try to do equal reps, sets, and weights with the front of your body as you do your back of body. It might take a while to even out!

Rotator Cuff Strengthening:

Warning!: If anything listed below hurts you, stop! Try lowering your weight. If it still hurts, then or after, ice it for 20 minutes, and write me: drjen@backsafegolf.com
These are small muscles, with very specific actions. Be precise with your form. Form is everything here, weight is nothing.

Here are the exercises I would recommend:

1. Supraspinatus/Empty can:
Weight: 3-10 lb. dumbbell. Don’t push this- it’s a tiny muscle. I use 5.
Reps: 2 sets of 12
Form: Stand with a dumbbell in each hand. Do one arm at a time. Raise your stiff arm in front, up away from your body to shoulder height, no further. Rotate the hand inward until you are in a thumb down position. In that thumb down position, lower the weight until your thumb hits your thigh. Raise it, never above the shoulder level. Move slowly. Note below, in the picture on the right, the shoulder is down and away from the ear. That is correct form. In the picture on the left, the shoulder is “scrunched” up to the ear. That’s not correct.
Do 12 reps. Do the other arm, and repeat both.

2. Subscapularis:
Weight: 10-40 lbs. Form is important here, so try it light first. I do 30 lbs. with a “healthy” shoulder.
Reps: 2 sets of 12
Machine: Set a cable pulley machine so the handle is at shoulder level. Use a D ring handle.
Form: Your back is to the machine. Grab the handle with a stiff arm. Raise the stiff arm out in front of you. The cable should run under your arm pit. The arm should be in the up position of the previous exercise, only palm down. Elbow locked, hand out at shoulder level. Hold your body and trunk stiff. Now translate ONLY your shoulder forward. Of course the arm and hand will move to, but it’s just a shift forward, leaving the rest of your body still. Don’t rotate your trunk. Your scapula will track along your ribcage, and your humeral head will push forward. You should feel this only lightly in under your armpit, actually in the front (anterior) surface of your scapula (shoulder blade).



3. External rotators: teres minor and infraspinatus:
Note: This is described and shown in the picture below for the left shoulder, but you should do all of these on both shoulders. You can then do the same thing on the other shoulder.
Weight: 5-10 lbs. I use 15 when my shoulder feels good, less when it doesn’t.
Reps: 2 sets of 12. Do Right arm, then left, and repeat.
Machine: Set cable pulley machine so the pulley and handle is at elbow height. Set your weight. This exercise can irritate, so better to err on the light side then the heavy. Use a D ring handle.
Form: Stand with your right shoulder to the machine, your left shoulder away. Hold the handle in your left hand with palm facing the machine, elbow bent to 90*. Glue your elbow to your ribcage. Keep your shoulder down and away from your ear. The inside of your forearm should be on your belly to start with. Move away from the machine until the slack is taken out of the cable. Now externally rotate your left upper arm, lifting the weight until your knuckles point straight ahead, now go a little further. Don’t force it into external rotation, it will hurt you. Lower the weight. Do 12 and go do the other arm, and repeat both.

4. Internal Rotators: pec. minor and subscapularis:
Note: This too is described for the right shoulder. You should do all of these on both shoulders also.  But, this is only going to be described this way.
Reps: 2 sets of 12
Weight: internal rotators are stronger and less vulnerable than externals, so I go a little heavier… 20-30 lbs. for a guy… I use 20 when I feel good, and less when I don’t. Know yourself.
Machine:  Leave machine in the same position as last exercise. Turn around so your right shoulder is to the machine. Glue your elbow to your ribcage. Keep your shoulder down away from your ear. Bend your elbow to 90*, knuckles pointing forward, and palm facing away from the machine. Step away from the machine to take the slack out of the cable. Rotate upper arm in to lift weight until the inside of the forearm is on your belly. Return the weight to almost touching the stack. Again, do not allow external rotation to the point of discomfort.  Repeat 12 times. Do the other arm. Do both again.

Read this again, sitting in front of the computer, do the exercises in the air. Do it a couple of times. Then when you go to the gym, you should be able to duplicate them.
Does this make sense? I hope it helps.

This is a great warm up before any upper body workout. It takes only 3-5 minutes once you get the hang of it, and it can save you problems later. IF, however, you already have a problem, try to get help from a good Physical therapist or Orthopedist and an okay before you go at this. You could even go as far as to print this out for them and ask if it's okay for you.

Dr. Jen Milus, DC
www.backsafegolf.com
www.fireagility.com

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Shaking After Training
By Dr. Jen Milus, DC, CSCS
www.fireagility.com

This question came across my desk:

Question:
I’ve been getting ready for the CPAT lately and I’ve noticed that as soon as I am finished with my daily workout I start shaking and do not function fully. Am I over doing the exercises? I am not in great shape but not in bad shape either.

I wear a 20 lb. weight vest while I workout. I start with warm ups and 30 push ups. Then I climb stairs at our basketball gym (16 times) and then I will run one mile.

 I don't feel like I am over exerting myself. Although, I just started 3 days ago and I am doing this all while my muscles are still sore from previous days. I am drinking both water and Gatorade.

Any ideas as to why I come out shaking?

Answer:

Shaking: Yes, people shake like that when they train harder than they are used to. You started out with something that was a bit ambitious. Ambition is a good thing. I shake after a workout that pushes me past my previous limit. I have been training with weights consistently for 28 years, so it has nothing to do with whether you are new at it or not- just how hard you pushed yourself.

When you push yourself past the limit that your muscles are used to, they twitch because they are “confused” or spasmodic. They have been asked to do something beyond their ability. When they finish, they don’t know quite when to stop, so they keep twitching.

Rest: Ambition is good, but: then it sounds like you did this workout 3 days in a row- never giving yourself time to heal the micro tears from the last workout. Training is a tearing down, then rebuilding process. Muscle atrophy requires both the training and the healing and repair time. Initially, I would train a day on, and a day off. In later stages, go to a split routine: maybe all pull one day, and all push the other, then rest the 3rd. Or upper one day, lower one day and cardio the 3rd and rest the 4th and start over. Just don’t do the same muscle group/same exercise 2 days in a row.

Be Specific: I would develop a plan to maximize your effectiveness at the exercises needed to pass your targeted department's physical/CPAT. Do this by looking at the things that need to be done, mimicking that set of tasks, then adding weight/resistance. This is known as task specific training. Job Specific Training

Progress:  Start easier and progress… working harder each time. Your plan must have a goal in mind, with certain times and weights, and tasks completed. Then work backward, in duration and weights, to where you can start with a workout that doesn’t make you shake or make you extremely sore. This should be in writing so that you can check off each time you work out and track your progress.

Here are some hints. Do super setting: one exercise, then another with another set of muscle groups.

Here's an example:
Warm up before every hard training session, and stretch after!
Put you weight vest on, then:
Super set:
10 pull ups
10 walking lunges, hands on hips
10 push ups
Run up and down the bleachers once
Start again.
Next set:
12 pull ups
20 walking lunges, hands on hips
12 push ups
Run up and down the bleachers once
Repeat.
I would start by going through 3 times (total) at first. This won't take long. Then add 1 time through per week until you reach a 30 minute workout.

This workout will work all your major muscle groups. It is only one small part of a plan- something to do a time or 2 a week. You will also need to do heavy leg press, lat pulls, squats and leg extension/curls. Also- training your core, in every direction (extension, flexion, rotation and lateral flexion) will help prevent back injuries later. (See Event #3 on this page: CPAT Events

I would not waste your time doing bicep or tricep training- or specific calf training either. Spend your time on BIG muscle group exercises- ones that move many joints at one time.

Be careful with the weight vest. Running and jumping with that on can be injurious to your discs. They won't ask you to run with it on in a test (unless they don't mind injuring people) so, don't subject yourself to that. Use a step mill or bleachers, and work up in weight- not up in pounding!

Dr. Jen Milus, DC

www.fireagility.com
www.backsafegolf.com

Biddle Addendum:

When taking the Biddle, there are several tests that are different than the CPAT. For that reason, there are changes in the training. You should go through your book at this point, and make a few changes.

There is no weight vest in this test. That means you don’t need to purchase one. But, you still need to do some intense cardio training to take you through this very intense test. Go through right now, and cross out weight vest work in red, and circle the chart below in red!

On the weight vest days:
You’ll need a standard stair/step. Take a dumbbell, wrap the hand part with a sweatshirt so it’s padded and can be rested on your shoulder. This will be picked up from the floor, put on one shoulder. You will step up and down, for the number of steps listed below. You’ll step up that many times on your right foot with the weight on your right shoulder. Then you’ll shift it to your left shoulder, and do the same number of steps. You’ll place the weight on the floor. You’ll do the stated number of walking lunges, and then you’ll return to the weight and step and repeat. You’ll continue this circuit for the time stated. Try to keep moving the entire time. Your heart rate should not be above 175 for the first 4 weeks, 180 weeks 5-9, and 185 weeks 10-12.
                                               
     Week              Weight       Steps R/L      Lunges Time

Save your back! Make sure you are bending and your knees and hips and holding that weight close to your body when picking up and placing down! Also, keep your chin up, and your head above your heart!

Walking Lunge Form

Remember that the form of your walking lunges is very important! If you do them carelessly, you risk your ACL (anterior cruciate ligament). Let’s just say: you’ll need it for later! See the drawing below! In the down position, your head and shoulders need to be centered over your hips. Your hips need to be equal distance between your front heel, and the ball of your back foot. In the down position, keep the weight in your front heel and the ball of your back foot. Your forward knee can be flexed to exactly 90*. Do not allow it to shift forward of your shoe laces, or bend more than 90*. Your back leg can drop down to tap your knee on the floor in the bottom of your lunge. Your pace should be: down 1, up 1, swing through 1 to contact.

There are 2 other variations of the workout!

The Ax chop is different in this test, so: Go through your workbook and cross out ax chop in blue and circle the chart below in blue! Your need to do it vertically!

The Ax Chop in the video is done horizontally. This won’t work for you! So, slide the cable up to the top of the machine. Now, put the rope pull on it that is used in the one armed lat pull. Stand about 2.5 feet from the machine in the position shown. Bend your knees. Stick out your behind. Keep your abs tight. Keep your back flat and your chest “sticking out”. Pull down in a quick chopping motion, keeping your elbows straight, but not locked. The hands should separate down by the quads, a few inches above the knees. Slowly let back to starting position on a count of 2.

 

You’ll also need to do more pec work for the Biddle!

Take a highlighter, and write “pecs” in the notes area of every day that has an ax-chop/over the shoulder hose pull super-set. Those are Tuesdays and Thursdays.

Let’s keep it simple. After you are done your ax chop and over the shoulder hose pull super-set, let’s do a few push ups! Later in the program, you may need to start on your feet and end up on your knees. Try not to stop and rest during your set, but if you have to, take a slight rest and finish!

Now, cut out these 3 charts after you are sure how to do the exercises, and paste them inside the back cover of your workbook!

Remember that this addendum is meant to go with the Milus Training Systems’ Fire It Up Training workbook Do not apply it without having both!
Let me know if I can help you in any way!

Dr. Jen

Question:

I am a firefighter

Since you guys are the pro's, you know what muscle groups need to be worked on for use in the fire service. Is there some sort of workout routine that I can make at home for building the important muscle groups? I can get into my turnouts and running shoes at home, but I need to know what muscle groups or routines I should practice most (ie: Cardio, Biceps, etc...)

My Current Routine:

I already do push-ups, because it's a must, maybe 30 a day. I also play Racquetball frequently.

Thanks!

Answer:

Dividing your training into muscle groups, like biceps, triceps, hamstrings, calves, etc, is the wrong way to think about it. I would focus more on functional training... exercises that imitate what you do on the job.

Since you are at home, make sure your push ups are with hands wide- this gets your lats and back more. And- get a chin up/pull up bar! You need to work your back as well as your pecs! If you don't you'll have back problems later!

I have heard of some great ideas like: dragging a sled with 50 or more lbs. on it across a parking lot and back.

Or: taking turns with a buddy, picking the other (over the shoulder) up and going up a flight of stairs... putting them down and both walking down together. Then the other guy is the carrier, then down... both without weight up and down, and start again.

Try Taping together hose bundles, each week increasing the size. Take it up 4flights of stairs. Put it down. Go down empty. Run up empty, pick it up and go down. This is great if you have a tower! Start again!

In the gym, do only major muscle group work. It's nice to divide things up so you can make sure you get rest. But, dividing them up does not mean doing small muscle groups EVER. Body builders do that. We are about function here, not vanity.

Try this in the gym: do a push day with your upper body: pec press, push ups, pec flies, shoulder press in front. If you are in pretty good shape, go to exhaustion/6-7 sets of each exercise. (Don't bother with lateral raises, or triceps, they won't help you).

Then do a day of cardio.

Then do an entire day of Pulling: Pull ups, lat pulls, bent over rows, seated cable rows, over the shoulder pulls- see here under event #2:

Again, if you are in shape, do several sets!

Take a day off.

Then do an entire day of big exercises for legs: Decline Leg press, Squats with free bar or Smith machine, walking lunges with weights (go up in weight each set!) Do several sets of each exercise! Finish with the 4 flight tower carries I mentioned above. STRETCH!

Do easy cardio on a bike and stretch.

Start over next week. Get creative, but be safe.

Dr. Jen
www.fireagility.com

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Nutrition for Firefighters

Introduction:
Try the best to follow these guidelines. Shoot for perfection and give yourself room to be human. I do not recommend people eat vegetarian because it disallows pure protein, which is most easily absorbed into muscle tissue. In short, I tried it, and it made me fat and weak. (And I was eating very healthy, whole foods). This is aimed at getting all your essential fatty acids, protein and vitamins necessary for health and strength building.

Shopping:
I shop at Whole Foods (or Whole paycheck, whichever you want to call it) when the budget allows. That’s not always possible. When it’s not, I make sure I wash my produce thoroughly with soap and water. The contents below are things one can get there. If you don’t have a store such as this in your area, try your local health food store.
Trader Joe’s has great rice mixtures and lots of cheap raw nuts and seeds.

NO:
hydrogenated oils/fats
white flour
white rice ( I will take you to whole foods and make you a rice mixture)
corn syrup
sugar
syrup/honey
you may only eat baby red new potatoes, otherwise, no potatoes.
no alcohol, save a glass of wine once  week
packaged creamers, but you can use (organic?) 1/2 and 1/2
processed food to the best of your ability

YES:
So, that leaves fresh raw fruits and vegetables, the rice I show you how to make, and pure protein, and raw nuts and seeds.

Protein:
Eat a fist size portion of pure protein with each meal. Pure protein is fish, eggs, low fat cottage cheese, chicken, lean pork, beef or other meat. When trying to put on muscle mass, eat 2 hard boiled egg whites every hour after your workout. This might interfere with a meal. Choose the eggs.

Fish:
Eat deep sea fish when given the choice between that and river fish. I don’t recommend eating trout or cat fish, and avoid bottom dwellers unless I just cant pass them up!

Carbohydrates:
Do not eat any unanswered Carbohydrates. That is: always eat a pure protein with your fruit/vegetable/grains. Eat only fresh fruits and vegetables, and eat them raw as often as possible.

Organic:
Try the best you can, within your budget to buy as much organic fruits and vegetables as you can. This significantly reduces the amount of poisons ingested, and allows your body to focus on the important thing: healing from your workouts.

Rice:
Eat ½ cup of cooked brown rice with lunch and dinner. No instant. Read on… the fiber here is important. Make a bunch on the weekend. 2 cups of water-maybe more to 1 cup rice mix. Boil, and simmer for 40-45 min. I like to add a cube of bullion- organic is possible and no MSG for sure. If you can’t get what’s listen below, try plain brown rice or a mixture found at Trader Joe’s.

In the rice mix: I make this mixture up in advance. Then I have it for later.
1 cup short grain brown rice.  Bin # 6687
2 cups mixed brown and wild rice. Bin #6670
2/3 cup sesame seeds- raw- black or regular.  Bin#6422
1/2 cup red wheat berries. Bin #5908
1 cup organic flax seed. Bin # 6407

Essential Fats:
If you don’t believe me, read Anne Louise Gittleman’s book, “Eat Fat, Lose Weight”. The right fats will help your body function better period- not to mention help you metabolize more fat off, and prevent heart disease. Twice a day, between meals, I eat a very small handful of this mixture of the raw nuts below. Remember that these bin numbers are those for Whole Foods. Trader Joes does not have bins.

In the nut mix: all raw:
2 cups spanish peanuts # 6354
1 cup pecans # 6366
1/2 cup pine nuts #6374
1 cup walnuts #6396
1 cup sunflower seeds #6433
1 cup macadamia #6304
1 cup cashews #6289
1 cup almonds #6269
1 cup pepitas- I lost the number

If you feel you have no hope of getting all this stuff, at least get a supplement, as listed below- of essential fatty acids and take that daily.

Nutritional Supplements:
Everyone should take a multi, period. Buy these at your local healthfood store, or some such place. The multis that are mass produced, like centrum, are usually so coated with stuff that they are not digestible. They often pass through the digestive track in scathed. If you do have to use these, you should chew them, and wash them down with a large glass of water.

Essential fatty acids: again, buy them at the healthfood store if you can. Take as directed.

If you have joint pain or joint problems, I recommend Glucoseamine Sulfate (not Glucosamine HCL) at 1000-1500 mg./day. MSM can be used for inflammation. Take both as directed.

Traumeel is a homeopathic cream/gel rub I use for sports injuries and muscle and ligament sprains and strains. Search it up on the internet if you need to. It’s cheaper there than in stores. It works extremely well during your training.

Meal planning:
I will give a daily plan here. It’s too complex to do many of them. Try to follow this exactly every day. The combinations are important, with respect to the ratios of carbs, fat and protein.

Breakfast:
            Large glass water with supplements
            3 egg whites/1 yellow or a scoop of low fat cottage cheese
            I piece of fruit
Snack:
            Small handful of raw nuts
            2 egg whites- especially if you are training hard.
            Large glass of water
Lunch:
            Large glass of water
            Scoop of rice mixture
            Fist sized portion of Protein: portion of tuna, chicken, lean beef, etc.
            Raw veggies- either a salad or a handful of other veggies
Snack:
            Small handful of nuts
            2 egg whites- especially if you are training hard.
            Large glass of water
Dinner:
            Large glass of water
            Scoop of rice mixture
            Fist sized portion of Protein: portion of tuna, chicken, lean beef, etc.
            Raw veggies- either a salad or a handful of other veggies
            A lightly cooked portion of veggies- fist sized

Forgiveness:
In order that you make progress in the changes you are trying to make, you need to practice forgiveness. If you fall off the “food wagon”, get over it, get back on it the next meal/snack.  And remember: Sunday!

Sunday:
Sunday is eat up day. You can eat what you want… in small portions. Don’t make a pig of yourself, just indulge a little bit so you don’t feel so denied.

Best of luck to you!

Dr. Jen

Oxygen Deficiency and Training Too Hard…

Dr. Jen Milus, DC
www.fireagility.com

Question:

You know that feeling you get when you're going all out during the physical ability course and the leg work is starting to make your lunch come back up? My inquiry has to do with the nausea/vomiting that occur after hardcore or strenuous leg workouts and workouts at high elevations.

I am from the west coast and I train right here at sea level. I run 4-5 miles per day 3-5 days per week, depending on my work schedule. Last year I was in the testing process for a department at 5500 ft. elevation and took their ability test that was very similar to the Biddle test. It consisted of Dry & Charged hose drags, extending a 35' ladder, 4 stories with a high-rise bundle, equipment carries, and the dead weight dummy drag on asphalt. All this while wearing a turnout coat, helmet, SCBA, and gloves.

Almost immediately after the test, I felt the strain on my thighs from the dummy drag. It felt like the sickness I get in my stomach from doing heavy squats at the gym. I started seeing the black and white spots and everything got louder. I removed my gear and found a nice little dirt clearing away from the other testers so I could vomit for about 5 minutes. It was a horrible feeling and my lungs were burning. I felt like I hadn't trained and I couldn't catch my breath. I trained extra hard for this particular test.

The following Monday I came to work (I work in an ER) and explained my experience to one of the Doc's. His only explanation was that I had trained at sea level and the test I had taken was at 5,500 ft. Elevation and the difficulty of the test were the two factors that created the response my body had.

What's the physiology behind the sick stomach feeling and the reason the elevation has such severe effects on an athlete even if they've trained and prepared for the physical ability test?

Answer:

I think I can help with this one!!!  I have had a similar experience.

I did the Oakland Test about 5 or 6 years back. See the details of this test:
http://www.pbs.org/itvs/testofcourage/life1_6.html
I did not fail (finished in 14 minutes 32 seconds- cut off is 17 minutes 55 seconds) but I was not happy with my performance. Here’s how it went:

You do all this other junk (see the site) Then, with a 40 lb. tank on your back, you have to carry a 40 lb. hose bundle up 4 flights of stairs over your shoulder (or however you could do it) and set it down. Then pull a coiled cable up to you and lower it hand over hand. Then pick up the big hose bundle, and carry it back down the 4 flights of stairs. I got the same symptoms: burning in the lungs and spitting like I was going to vomit (although I did not). My lungs burned for a week. It’s from Oxygen deficiency. This can come about from lack of oxygen supply in the air or lack of your ability to process what is in the air. I was simply not prepared for the test, and given your circumstances, sorry, but neither were you.

 If I had known what was going to hurt me during the test, and how I was going to feel, I would have trained completely differently.

The areas where I was not prepared?

1. I didn’t how about the 40 lbs was packaged beforehand. It really is not that much weight- until you already have 40 lbs. on your back. I practiced carrying two 35 lb. dumbbells up 4 flights of stairs. The hose bundle needed to be carried over my shoulder up those stairs. Not only was the total of 80 lbs. a lot of weight for my size, I have very bony and sharp distal clavicles. Both of those things jamming down on my boney shoulders really hurt. There is no way to change my anatomy- I am boney in places I cannot control.

BUT:  If I have practiced exactly what was expected, I would have either taped some pads on my shoulders underneath my t-shirt, or I would have toughened them up by carrying something that resembled the hose bundle/tank straps, so the shock of the hardness wouldn’t have been so painful.

2. I needed to do more extreme cardio work. I would have done a lot more heavy lifting with my legs than I did. I only did cardio before that test. Running, jumping rope, versa climbing, bicycling and rock climbing were not enough. I need to be doing interval training/super sets with heavy leg press and jump rope with heavy squats. These super sets  needed to be done for long periods- 20 minutes- back and forth, back and forth, getting heavier and heavier each time.

What about the Vomiting due to Oxygen Deficit?

Oxygen deficiency is why you were throwing up. Yours was caused by elevation, mine was improper training. That’s your body’s way of telling you, “Hey Stupid, STOP! That is more than I can handle!”

Solutions:

1. Proper training: More super-set weight intervals. You had not trained properly.

2. Extra Oxygen binding support?

I recently had an experience with a lacrosse team I coach that might help you. We train them at sea level, and took them to Vale Colorado to Play in the Vale Shoot Out. Right before I left, I found this stuff at the health food store, and thought I would give it a try. It's called Aerobic O7, subtitled stabilized Oxygen. The nutritionist at the store told me it worked really well to help Red Blood cells bind more oxygen. I was skeptical too. But, I figured it was worth a try.

I started using it on most of the players- 8 drops per bottle of water they drank- up to 4 bottles like this per day. The first day in Vale, 2 kids got elevation sickness- headache, nausea, shortness of breath, and had to discontinue play. Neither of those kids had started the Aerobic O7 stabilized oxygen drops. The other kids who were using it were fine. They played extremely well, and even beat the home team- which no one else in the tournament could keep up with (every visiting team was low-landers).

Further, I get elevation sickness- the headache and stuffy sinuses every time I go up high. I used the stuff in Vale, and felt great.

We left from Vale, and played in New Jersey. I stopped giving the kids the drops when we landed in Jersey because I figured they didn't need them. I think the effectiveness lasted, though. They ran the east coast teams into the ground. This is unheard of with the humidity that California kids are not used to, plus the experience and skill level of east coast kids is usually higher. But, our kids had way more energy. This tells me it might just be great at sea level for any training.

Here's the kicker: 3 weeks later, we took them back to the east coast-to Maryland. I didn't take the drops. The kids were weak, and tired and slow. The same kids, same team…were getting run into the ground. They still played pretty well, but they were slow and tired. We had been training and practicing them harder over the past 3 weeks than before the Vale and NJ tourneys. There was no reason for it. Several of them asked if I had the drops, and I had to say no. I think those drops made a difference, and they thought so too!

So, the morale to the story is: The strangest things will help us.... and thinking outside the box can really beneficial.

Their website is http://www.aerobiclife.com
Try it- it worked for them, and it might just work for you.

Here’s my leg workout when I am trying to get ready for something like you speak of:

For Leg Press Exercises described, see Firehouse Butt-kicking Circuit Training and read, read. read!!!

5 minutes warm up stationary bike

Super Set 1: Decline leg Press- 1  45 lb. plate on each side, 20 reps- add plates
No rest
Jump rope for 60 seconds

Super Set 2: Decline Leg Press- 2  45 lb. plates on each side, 18 reps- add plates
NO rest
Jump rope for 60 seconds

Super Set 3: Decline leg Press- 3  45 lb. plates on each side, 16 reps- add plates
No rest
Jump rope for 60 seconds

Super Set 4: Decline leg Press- 4  45 lb. plates on each side, 14 reps- add plates
No rest
Jump rope for 60 seconds

Super Set 5: Decline leg Press- 5  45 lb. plates on each side, 12 reps- add plates
No rest
Jump rope for 60 seconds

Super Set 6: Decline leg Press- 6  45 lb. plates on each side, 8 reps- it’s getting heavy here…
No rest
Jump rope for 60 seconds

Super Set 7: Decline leg Press- 7  45 lb. plates on each side, 6 reps- add plates
No rest
Jump rope for 60 seconds

Super Set 8: Decline leg Press- 8  45 lb. plates on each side, 4 reps- add plates
No rest
Jump rope for 60 seconds

Do as I say, not as I do:
Always have a spotter, know your limits, and you really need to work into this! I have spent years getting here- ever since that ugly tower experience!

Then, the next Super set is:

Then: Walking lunges, Leg extensions and Leg curls:

Super Set 9: OMG… legs are getting tired now… weights different with different machines…
24 walking lunges empty handed
Leg extensions: 70 lbs. 20 reps
Laying down Leg Curls: 60 lbs. 20 reps

Super Set 10: OMG… legs are getting really tired now…
24 walking lunges 5 lbs in each hand
Leg extensions: 80 lbs. 14 reps
Laying down Leg Curls: 55 lbs. 14 reps

Super Set 11: OMG… I think I might die right about now
24 walking lunges 10 lbs in each hand
Leg extensions: 90 lbs. 10 reps
Leg Curls: 60 lbs. 10 reps

Super Set 12: OMG… I am shaking now, and really near my end
24 walking lunges 15 lbs. in each hand
Leg extensions: 100 lbs. 6-8 reps
Leg Curls: 70 lbs. 6-8 reps

Stretch!!!!
Go home, eat, shower and pass out.

Best wishes

Dr. Jen Milus, DC
www.fireagility.com

Heart Disease in Firefighters #1 Killer!

Here are the statistics for the population at large:

• Cardiovascular Disease, aka Coronary Heart Disease, is the #1 killer in US today!
• 950,000 Americans died last year of this silent disease.
• It accounts for 40% of all deaths in the US.
• 1 in 4 adults have CVD
• 1 death/minute among females, 6X’s all other causes combined
• If CVD was eliminated, life expectancy would rise 7 years!
• Stress increases blood pressure and increases morbidity and mortality of those afflicted with Cardiovascular Disease!

For Firefighters:

• 1/3 of firefighter deaths so far this year (2007) appear to have been due to Cardio vascular disease!
• Researchers believe mental stress and overexertion combined with factors such as being overweight and in poor shape may increase the risk of dying from heart disease.

Firefighters have one on the most stressful jobs around! Many firefighters are overweight and lack adequate physical fitness, which may be contributing risk factors.

What can YOU do to add years to your life?

Let’s start with understanding:

What is Cardiovascular Disease?

It is the actual hardening of the arteries. This hardening is actually clogging. This clogging causes a restricted blood flow and a decrease in oxygen allowed to flow to the muscles.  Then when the muscles are called on to do extra work (like pull a hose), the heart has to work all that harder. The more brittle vascular system takes a beating, and the vessels scar and clog even more.

What does it look like?

Vasoconstriction is the narrowing due to plaque and hardening. Visualize globs of chewing gum stuck to the insides of your garden hose. As the water passes through, there is less space for the flow. Heck, you guys understand flow and fluid dynamics! As time goes on, and we age and watch our nutrition less closely, the gum wads increase in size and number. Imagine these gums wads are sticky, and attract more of the same…. Like they want their friends around! Flow is further restricted.

Viscosity is the thickness of a fluid, and is inversely proportional to its ability to flow. Oil is more viscous than water. Toothpaste is more viscous than oil. Jello is more viscous than toothpaste.  Blood is more viscous with more fat globules in it than when it doesn’t have them.

You won’t believe how drastic and how fast this works! Draw blood on someone 30 minutes after having a big mac, fries and a milk shake. Put the blood in a vile and put a stopper in it. Let is sit for 5 minutes. What you see will open your eyes. Have a trash can nearby. You might feel like barfing.
 
The blood, when it is more viscous, has problems flowing past these plaques on the sides of the blood vessels. This makes the heart work harder to push the blood through. In essence, it wears your heart out faster.

Turbulence: as particles adhere to the walls (plaque), this increases the swirling of the blood as it passes. This further increases the resistance to flow making your heart work even harder.

Let’s talk about STRESS!!!!

When a body is in a stressful situation, it adapts with the fight or flight response. This is achieved with the release of adrenaline (cortisol) from the adrenal glands. One of the effects of cortisol is vasoconstriction, which results in an increase in blood pressure, and again more work for your heart!

Firefighters enter the fight or flight/stressful situation on just about every call. People can become somewhat “used to” this… accommodate to it. But, face it, we are all human. The things you guys (and gals) see can be so incredibly tragic; a physiologic reaction cannot be avoided. 

Evaluation: Some Numbers:

Hypertension/High Blood pressure:

You guys (gals) know these numbers, but I’ll put them here anyway:

140/90 high
            120-139/80-89 pre-htn
            119/79 normal
            systolic/diastolic

When was the last time you took your blood pressure? Where do you fall?

Body Mass Index is a great way to predict whether you are at risk for heart disease. You calculate it by dividing your weight in kilograms by your height in meters. It’s quick and easy. People who are extremely muscular- take that into account before you are too hard on yourself. At my leanest, 12 % body fat, I fall in around 25-26. But, I am extremely healthy. Take it with a grain of salt.

Risk Factors for Heart Disease:

Obesity: BMI- see above.

High Blood Pressure: above. Remember, each time you get your heart rate up by exercising, the more able your heart is to handle the rise when in a stressful situation.

Smoking: This increases your risk of CVD by 50-60%. It’s an addiction, I know! But… please! I smoked as a teenager and in my early 20’s. Being  a fitness/healthcare professional… well, let’s just say, I have to look at myself in the mirror every day. If I am true to myself and my purpose in life, then smoking cannot be included. If I smoked, I would be telling you to do as I say, and not as I do. When you go on those calls, and see the damage done to the people with COPD… I just know none of you actually smoke, right?

Genetics: family history. I get this part- but who taught us how to eat?

Diabetes: increases plaque in the blood vessels. It is my belief, after years of study, that diabetes is on the rise, along with heart disease, because processed food causes a rise in blood sugar. Stay away from high sugar foods and processed carbohydrates- such as white flour. Eat any carbohydrate with some protein to keep the glycemic index of your food down. This will give your pancreas a break, and lesson your chances of developing DMII, and reduce your problems if you already have it.

High Cholesterol:
High cholesterol is considered among the primary causes of heart disease.
Cholesterol is a waxy, fat-like compound that belongs to a class of molecules called “steriods.” It’s found in many foods, in the bloodstream, and in all body cells. Cholesterol produces deposits in the arteries, which impedes blood flow. A handful of cholesterol might feel like a soft melted candle.

However, Some Cholesterol is needed because it is used to form and maintain cell membranes and in the manufacturing of sex hormones. It is used in the production of bile salts, aiding in digestion. And, it converts Vitamin D (with the suns help) in the skin so that our bodies can absorb calcium from our food.

Total Cholesterol and Triglycerides are monitored and should not be above certain numbers: see below.

Good Cholesterol:
High-Density Lipoproteins or “HDL” is the good cholesterol.  HDLs carry unneeded cholesterol away from the cells and back to the liver where it can be broken down for removal from the body. Low levels of this cholesterol is associated with an increased risk of heart disease

Bad Cholesterol:
Low density Lipoproteins or LDL are bad cholesterol. LDL are considered to be a major contributor to plaque buildup in the arteries and impeded blood flow to the heart and other areas. For every 1% drop in LDL, the risk of heart attack drops by 2%.

Guidelines:

Total cholesterol  should be 200mg/dl or below.
LDL should be less than 130 mg/dl
HDL should be greater than 45 mg/dl
Triglycerides should be less than 150 mg/dl

Ratio*: LDL:HDL

• Ratios: Cholesterol to HDL no higher than 4:2

            LDL to HDL no higher than 2:5

*This ratio indicates your Cardiac risk factor- they reflect whether cholesterol is being deposited into the tissues or broken down and excreted.)

These Cholesterol Numbers and the Average American:

The average daily cholesterol consumption of most Americans:
            males  ~360 mg/day
            females  ~240 mg/day
The American Heart Association recommends less than 300 mg/day!

Solutions:

Dietary Fat:

Much of this information was found on the Website for Smart Balance Products: http://www.smartbalance.com/foodplan.html

The body needs a certain amount of fat. If this essential fat is not eaten in the normal diet, a person will crave fat of any sort to get what the body needs. Unhealthy fat comes along with the fats that are needed. This adds fat to our bodies and clogs our arteries!

The balance of types of fat we eat is based on research done by scientists at Brandeis University. These researchers improved the ratio of HDL "good” to LDL "bad" cholesterol by using a specific balanced blend of fats as a significant part of a healthy varied diet. The American Heart Association Step 1 Diet guidelines were used. This suggests to limit total fat to 30% of calories consumed; saturated fat to under 10%; and dietary cholesterol to under 300mg per day.

This balanced fat diet provided approximately equal proportions of the three principal fatty acids: polyunsaturates, monounsaturates and saturates. It avoided the use of trans (read as hydrogenated- see your labels) fatty acids in foods and included regular exercise. Subsequent studies have increased the proportion of monounsaturates in the balance of fats.

It is my opinion that the products that Smart Balance has made based on this research is healthy, and should be considered as substitutes for any and all fatty products in one’s diet. They have everything from Mayonnaise to buttery spreads and salad dressing. I use them. Even my daughter loves the peanut butter.

Not Just Fat Balance:

Essential fat can be absorbed through good nutritional sources. Here are some simple hints:

• limit saturated fats to 10% of calories
• Avoid foods with hydrogenated oils and trans fatty acids in baked goods, fried foods, regular shortenings and margarine.
• Substitute in Smart Balance Products
• Eat a generous supply of fruits and vegetables. I recommend 5 servings per day
• Evidence is building that Omega-3 fatty acids may be helpful in reducing heart disease risk. Eat fish 2-3 times per week. This will increase your Omega 3 fatty acids. Vary the type and source, try to keep to cold water fish such as salmon and sardines.
• Eat raw nuts, never roasted or cooked. The heat they are cooked in alters the chemical make up of the oils they contain, and they can become dangerous trans fats. When raw, they are a good source of healthy oils and fiber.
• Use oils to cook with: olive, walnut, sesame,
• Essential Fatty Acids in supplement form are a good way to alter Cholesterol ratios. Taking them will curb your cravings for fat by giving your body what it needs.
• Take a look at this web site:

http://www.smartbalance.com/foodplan.html

Exercise!!!!

12% or 250,000 deaths annually result from a lack of exercise!

 How is this possible?

 A 2005 study by the National Fire Protection Association showed that more than 70% of fire departments lacked fitness and health programs. Oh my gosh!

Where to start with Cardio Training:

12 minutes of cardio 3 times a week is a great place to start!
Firefighters should really be doing a minimum of 1 hour per day of exercise. This should be a combination of cardio and resistance training. Below is a chart of how to train, alternating cardio and resistance to regain your health as a firefighter. This is by no means a training plan for taking the CPAT or any other agility test.

The step mill training is for use without, then with a weight vest. This is something you should do if you are on active duty, as you will need this more intense training. Another cardio machine could be substituted in if you do not have access to a step mill. Check with your doctor before you start this, or any exercise program. Remember- this is just to get you started!

Mentioned in the chart is circuit training. The times are mentioned because you can stop any time within a circuit. If you have problems with blood pressure and or cholesterol, ask your doctor specifically if you can train with weights before you use the recommendations here:

http://cms.firehouse.com/content/article/article.jsp?id=51607&sectionId=8

If you have questions or comments, please do not hesitate to write!
Best wishes for you health!

Dr. Jennifer N. Milus, DC
Author of Fire it Up!
www.fireagility.com
www.backsafegolf.com

Low Back Injuries lead to Disabled Firefighters!
Dr. Jen Milus, DC
www.fireagility.com

Support of the low back is very important. If you have had trouble with your low back, it might be due to weak, untrained muscles in your core. Below is a discussion of things you can do to strengthen and prevent further and later back injuries. Do not start this workout if you are in the midst of a low back episode. Do not continue it if it makes you extremely sore, or sore for more than 2 days!

If you are in pain right now, you need to address that first. Read here: http://cms.firehouse.com/content/article/article.jsp?sectionId=8&id=50160
Please also consult with your chiropractor, orthopedist or family doctor to rule out pathology!

In order to protect your low back in awkward situation, I suggest training in four “ranges of motion”.  I will show and explain three very simple exercises to work:  forward flexion, rotation, lateral flexion, and extension.

Forward Flexion and Rotation:  
Bicycle abs:
I find the best, fastest and most effective exercise to be bicycle abs. It works upper and lower abs, plus obliques.
One can do these on the floor, or on a bench as shown here. Rotate and lift the upper body to touch the elbow to the opposite knee, and hold for 1 second . Exhale as you touch the elbow to the knee, and inhale as you cross the center to go to the other side. The other elbow should be below the level of the bench, allowing for maximum rotation.
   

Start with 4 sets of 50. Aim at 10 sets of 100 over several months. Yep- that's a lot. If you do a set of 50 (later work up towards100) between sets of all your other exercises, its' easy to get done.

Extension:

The Extensors of the low back can be trained either on a ball, as shown here:
Lay on top of the ball, belly button at the highest point on the ball. Hands are behind your head. Feet in the corner where the wall meets the floor, toes out. Lightly squeeze the ball with your inner thighs, and take a deep breath. Lift up until your spine it totally straight, exhaling as you lift. Inhale as you lower. Try 6 reps the 1st time out. This exercise is difficult. Stop if your low back hurts! Work up to 4 sets of 20 over several months.

You can also accomplish the same on the hyper extension bench in the gym.

Here’s a pic of the hyper-extension bench. Note, the bench in this photo is being used in lateral flexion. I intend that you use the bench face down here. You would hook the backs of your heels under the same place where you see my feet braced. Flex forward, arms over your chest. Come up only to straight. It is called a hyperextension bench, but DO NOT hyperextend. Come up only to straight/level with your legs/the floor. Hold for 2 seconds, and lower slowly.

Start with 2 sets of 10, and work up over several months to 4 sets of 20. You may add weight later. If your bench is at an angle, with your feet down, this exercise will be a lot easier, and you will need to hold a weight to your chest. By the way, this exercise and make your hamstrings really sore. Stretch them when you are done!

Lateral Flexion:

Look again at the lateral flexion bench picture:

As shown in this picture, your hip is right in the middle of the pad to the caudal end. There should be a split there in the bench for it. Your feet should be wrapped around the post at that end of the bench. Top leg should be back. Keep your range of motion small at first, and make it bigger over months as you get stronger. Start with a set of 6 on each side the first time, and see if you are sore the next day. Be very careful! Of all these exercises, this is the toughest one.

You can work up 4 sets of 12 on each side over several months. Since I started doing this exercise, I NEVER have low back pain any more. The musculature in my trunk simply won’t allow my low back to go out! Try it, but listen to your body.

Most gyms also have this bench at a slant, or flat like I have shown here. The slanted one makes the exercise much easier! If you are a real beginner, start there! Please know your body, and exercise at your own risk!

We are made to have really strong ab muscles. So, I do 1000 bicycle abs every day if I can. (Thus the 6 pack) If you get really sore, take a day or 2 off, and let yourself heal!

The other exercises are pretty tough and should not be done more than every other day at most. BUT: No less than 2 times per week.

Always stretch these areas out after training them!

I hope this helps!

Dr. Jen
www.fireagility.com

Proper lifting techniques for EMTs and Paramedics

Dr. Jen Milus, DC
www.fireagility.com

Low back injury is the most costly and most debilitating of all work injuries in America today. So how do we avoid it? Proper lifting technique and proper exercise are the 2 best ways to stave off this injury.

Low Back Pain

If you are already in pain, many of the suggestions below will be improper for you at this time. If you are interested in learning more about self care of low back pain, click here, http://www.fireagility.com/articles.php , scroll down to the 3rd article read the article on low back pain. You may need to see a doctor. Make sure it is safe before you do anything that is discussed below.

Proper Lifting Technique

In order to lift heavy objects and people safely, one must have a very good awareness of their body, and which muscles are contracting with any given movement. For the purposes of this article, I am going to assume that the reader is familiar with the major muscle groups of the trunk, pelvis, hips and legs.

First: get yourself into proper position. Get yourself as close to the object you are intending to lift as possible. Feet are apart for a stable base. If it’s possible, have your toes underneath the edges of the gurney, or feet as close to the body board as possible.

Second: get your abs tight and you back flat. Hold those two until the lift is complete.

Third: As you lift, do so with your legs. Keep your weight in your heels and the balls of your feet. Push up, tightening your hips, hamstrings and gluts as you rise. Keep the object close to you. Keep your back flat and your abs tight.

Fourth: Once you have risen, and want to put the gurney into the ambulance, do so with your feet. Try not to pivot at your waste, but do so with your feet. Try to keep your shoulders in the same plane with your hips. You may need to shuffle your feet to keep them properly under your base. That’s fine.

Again, as you slide the gurney in, shuffle your feet sideways rather than twisting at your waste. The discs in your low back will thank you for your efforts.

Trunk stabilization:

Support of the low back is very important. If you have had trouble with your low back, it might be due to weak, untrained muscles in your core. Below is a discussion of things you can do to strengthen and prevent further and later back injuries. Do not start this workout if you are in the midst of a low back episode. Do not continue it if it makes you extremely sore, or sore for more than 2 days!

In order to protect your low back in awkward situation, I suggest training in four “ranges of motion”.  I will show and explain three very simple exercises to work:  forward flexion, rotation, lateral flexion, and extension.

Forward Flexion and Rotation: 
Bicycle abs:
I find the best, fastest and most effective exercise to be bicycle abs. It works upper and lower abs, plus obliques.
One can do these on the floor, or on a bench as shown here. Rotate and lift the upper body to touch the elbow to the opposite knee, and hold for 1 second . Exhale as you touch the elbow to the knee, and inhale as you cross the center to go to the other side. The other elbow should be below the level of the bench, allowing for maximum rotation.
   

Start with 4 sets of 50. Aim at 10 sets of 100 over several months. Yep- that's a lot. If you do a set of 50 (later work up towards100) between sets of all your other exercises, its' easy to get done.

Extension:

The Extensors of the low back can be trained on a ball, as shown here:
Lay on top of the ball, belly button at the highest point on the ball. Hands are behind your head. Feet in the corner where the wall meets the floor, toes out. Lightly squeeze the ball with your inner thighs, and take a deep breath. Lift up until your spine it totally straight, exhaling as you lift. Inhale as you lower. Try 6 reps the 1st time out. This exercise is difficult. Stop if your low back hurts! Work up to 4 sets of 20 over several months.

You can also accomplish the same on the hyper extension bench in the gym.

Here’s a pic of the hyper-extension bench. Note, the bench in this photo is being used in lateral flexion. I intend that you use the bench face down here. You would hook the backs of your heels under the same place where you see my feet braced. Flex forward, arms over your chest. Come up only to straight. It is called a hyperextension bench, but DO NOT hyperextend. Come up only to straight/level with your legs/the floor. Hold for 2 seconds, and lower slowly.

Start with 2 sets of 10, and work up over several months to 4 sets of 20. You may add weight later. If your bench is at an angle, with your feet down, this exercise will be a lot easier, and you will need to hold a weight to your chest. By the way, this exercise and make your hamstrings really sore. Stretch them when you are done!

Lateral Flexion:

Look again at the lateral flexion bench picture:

As shown in this picture, your hip is right in the middle of the pad to the caudal end. There should be a split there in the bench for it. Your feet should be wrapped around the post at that end of the bench. Top leg should be back. Keep your range of motion small at first, and make it bigger over months as you get stronger. Start with a set of 6 on each side the first time, and see if you are sore the next day. Be very careful! Of all these exercises, this is the toughest one.

You can work up 4 sets of 12 on each side over several months. Since I started doing this exercise, I NEVER have low back pain any more. The musculature in my trunk simply won’t allow my low back to go out! Try it, but listen to your body.

Most gyms also have this bench at a slant, or flat like I have shown here. The slanted one makes the exercise much easier! If you are a real beginner, start there! Please know your body, and exercise at your own risk!

We are made to have really strong ab muscles. So, I do 1000 bicycle abs every day if I can. (Thus the 6 pack) If you get really sore, take a day or 2 off, and let yourself heal!

The other exercises are pretty tough and should not be done more than every other day at most. BUT: No less than 2 times per week.

Always stretch these areas out after training them!

I hope this helps!

Dr. Jen
www.fireagility.com

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