FrameWork: Your 7-Step Program for Healthy Muscles, Bones, and Joints

“We all know that exercise is good for us, but too much of a good thing - or the right thing done wrong - can lead to serious musculoskeletal problems.

Carey, an exercise physiologist, and DiNubile, a sports medicine physician, have each written a book that will help people safely start, maintain, and build an exercise program. Both authors take philosophical approaches rooted in therapeutic modality, meaning that they prescribe exercises based on the interaction of the whole body. Carey believes that many musculoskeletal problems result from muscular length and strength imbalances. To correct these imbalances, he has developed the Function First program, which focuses on proper body alignment, kinesthetic awareness, and core body strength and stability.

DiNubile, meanwhile, presents many of the same core body exercises as Carey; to boot, there is an extensive preexercise screening questionnaire and advice on aesthetics, weightlifting, diet, and seeking medical advice in case of injury. Both titles are well organized, include helpful illustrations, and impart advice that is in line with what trainers today are offering at many top health clubs. Both are highly recommended for public, consumer health, and human resource collections.” —Howard Fuller, Stanford Health Lib., Palo Alto, CA, Library Journal

A renowned orthopedic surgeon provides the first medically proven fitness program designed to help prevent the #1 reason for doctor visits in the United States--bone and joint problems
Fitness can't be just about a healthy heart or looking good in a swimsuit. After all, low cholesterol and a flat stomach won't get you very far if back or neck problems, or a worn out knee or shoulder, keep tripping you up.

This first-of-its-kind program is designed to ensure that your frame can go the distance, with durability to match the muscle tone and conditioning we all want. And unlike other workouts, Framework starts with a unique self-test that uncovers potential problems with your frame, your workout, your nutrition, and more. It even combines diet and lifestyle advice with a balanced, customizable workout that acknowledges the fact that our bodies are all a little different and often need special attention. It teaches you to pay attention to what your body tries to tell you, and when it is being challenged by a special problem, whether it is a heel spur or stress on the job.

Best of all, Nicholas A. DiNubile, M.D., who serves as orthopedic consultant for the Philadelphia 76ers as well as the Pennsylvania Ballet, shows you how to work around--helping without hurting--any muscle or joint problems you may already have. And it all takes only 1 hour a day, 3 days a week.

NICHOLAS A. DiNUBILE, M.D., a specialist in sports medicine named one of the "Best Doctors in America," is clinical assistant professor in the department of orthopedic surgery in the Hospital of the University of Pennsylvania. He lives in the Philadelphia suburbs.

WILLIAM PATRICK, a former publishing executive, edited such self-help classics as Minding the Body, Mending the Mind and the #1 New York Times bestseller Iron John. Recent writing collaborations include Sidney Poitier's The Measure of a Man and Robert Schuller's My Journey. He lives near Boston.

ONE

A DIFFERENT KIND OF FITNESS

WITH JOSE REYES AT SECOND BASE AND KAZUO MATSUI AT SHORTSTOP, THE NEW York Mets thought they'd acquired baseball's most dynamic duo for the double play. But as spring training for the 2004 season drew to a close, the two young stars had yet to appear together on the same field.

Reyes was out with a pulled hamstring, and Matsui was sidelined with a strained wrist. Having gone 8 years in the Japanese major leagues without missing a game, Matsui, 28, had been considered something of an iron man. But Reyes, only 20, had already become an orthopaedics frequent flier.

During his rookie year, Reyes was benched three times with hamstring trouble, a problem that began for him at age 14. As a youngster back home in the Dominican Republic, Reyes had been running up the stadium steps to strengthen his legs when he heard something snap. Trouble is, once you pull a hamstring, chances are you will do it again. That's because the muscle heals with scar tissue where healthy cells used to be. Early on in the rehab process, you can reduce the negative effects of that scarring, but it takes a lot of time and a lot of conscientious effort. Once the muscle heals, if you haven't taken full advantage of that window of opportunity, then you get far denser scar tissue with no elasticity. If you look at the muscle under a microscope, instead of the bands lining up parallel and behaving like a spring or bungee cord, the structure is more haphazard, which makes it a lot less flexible, and thus more vulnerable--a weak link.

For Reyes, quick, darting movements and sudden lunges are his stock in trade. These movements require sudden contraction of the quadriceps, the muscle in the front of the thigh. This, in turn, requires a quick relaxation and lengthening (eccentric contraction) of the hamstring, the muscle in the back of the thigh. Unless a strong quad is balanced with an equally strong and flexible hamstring, the imbalance is bound to cause trouble.

Whether you play second base or second fiddle, whether you crank miles on the track or code on your computer, you need a frame you can count on. That's why the modern definition of fitness isn't just aerobic capacity, or muscle tone, or the absence of fat. True fitness needs to be from the foundation up, and that means fitness for all the cells and tissues that make up your musculoskeletal frame.

In the old days of baseball, Babe Ruth played until he was 40, but the photographs show an old man with spindly legs and a potbelly, to some extent coasting on his legend. The classic sports novel North Dallas Forty, written in the 1970s, portrayed thirty-something pro football players as broken-down old men, hobbling to the stadium, then numbing themselves with painkillers and injections to get through a game. Famous as a great running back before he became infamous as a criminal defendant, O. J. Simpson could be the poster child for this old-school approach to fitness. At his trial for the murder of his wife and her companion, the defense argued that this once great athlete had so many bone and joint injuries, especially to his knees and ankles, that he could barely walk, much less overpower two healthy people! No amount of conditioning is going to fully protect a knee in the National Football League, but today's superstars have redefined conditioning and, as a result, are redefining athletic staying power.

In 2003, Sports Illustrated described Oakland Raiders receiver Jerry Rice, then 39, as having "carved up the New York Jets' secondary like a honey- baked ham." In that one game, this "middle-aged man" had nine catches for 183 yards and a touchdown.

That same year, in the National Basketball League, 4 days after turning 40, Michael Jordan scored 43 points in 43 minutes, helping his Washington Wizards defeat the New Jersey Nets, 89-86. He had 10 rebounds, four steals, burst past the opposition to make the game-winning layup, and dived to the floor to save the ball after making a first-quarter steal.

When iron man pitcher Nolan Ryan threw his seventh no-hitter at age 44, and Cal Ripken hung in for 2,632 consecutive games, they were pioneers in terms of durability. But as of 2003, major league baseball had 11 players over 40. As the 2004 baseball season began, Roger Clemens, 41, was still throwing a 96 mph fastball. And on May 17, 2004, Randy Johnson (age 41) warmed the hearts of aging jocks everywhere by pitching a perfect game against the Atlanta Braves, sending 27 youngsters back to the bench without a single hit. In his next outing, against the Florida Marlins, "the Big Unit," as Johnson is called, continued his streak for three more innings before giving up a hit, making a total of 39 batters retired in a row--two short of the major league record. Not bad for an old guy.

Track and field has Regina Jacobs, who at age 40 broke the world indoor record for 1,500 meters. Golf has Jay Haas, who in the spring of 2004--at age 50--was playing so well that some had him pegged to win the Masters. Hockey has Mario Lemieux, who came out of retirement, overcoming cancer and chronic back problems, to captain the Pittsburgh Penguins at age 37. And tennis has Martina Navratilova, who in 2003, at age 46, became the oldest player to win a championship (mixed doubles) at Wimbledon. In 2004, she became the oldest person to win a singles match at Wimbledon!

Part of the reason for this athletic longevity is that these players entered the world of serious athletics at a time when serious conditioning was coming into fashion.

Unfortunately, the benefit still hasn't reached everyone.

Too many great young athletes--University of Connecticut basketball's All- American Shea Ralph is a perfect example--see their dreams shattered for no other reason than a faulty frame.

SIDELINED BY A FAULTY FRAME

Former basketball great Shea Ralph could be the poster girl for the epidemic of knee injuries among female athletes. She's also living proof that no matter how much talent and heart you bring to the game, it doesn't get the job done if your frame gives out on you.

This tall blonde from North Carolina was a dream player with a brilliant future in women's basketball. In 1995-96, she was USA Today's "High School Player of the Year." In 1996-97, she was "Freshman of the Year" in Sporting News and "Big East Conference Rookie of the Year." In 2000, she was captain of the University of Connecticut women's basketball team that won the NCAA Championship. In 2000, Shea Ralph was an All-American, as well as MVP of the Final Four.

But when it came time to turn pro, and Ralph was drafted by the WNBA's Utah Starzz, she was never able to play. By the end of her college career, Shea had lost her anterior cruciate ligament (ACL) on both sides. In all, she has had to endure six different knee operations.

Her troubles began in the first round of the 1997 NCAA tournament when a fast break turned into an agonized tear in her right ACL. Three days later she had her first reconstructive surgery.

The following year she was redshirted after reinjuring that same knee during a workout. She had her second ACL surgery in September 1997.

It wasn't until 1998-99 that Ralph had her first collegiate start--she made up for lost time by scoring 36 points against Boston College. But then she missed four games with a sprained medial collateral ligament, again in the right knee.

In 2000, Connecticut won all the marbles, and things were looking good for Ralph's career. Then, in March, 2001, during the first half of a game against Notre Dame for the Big East Championship, she went in for a layup along the baseline, and the crack could be heard throughout the gym--only this time it was her left knee! Another ACL tear.

Today, Shea Ralph contents herself with being assistant coach of the University of Pittsburgh women's basketball team.

In an interview with the New York Times, Ralph said that, for a while, she was so bitter about her injuries that she could not even watch basketball on television. Since that low, she's found ways to bounce back and throw herself into the challenges of coaching. But she admits, "I still miss it. I won't lie to you. I really, really would have loved to play pro." We now know that many ACL tears can be prevented by changing the way you condition your frame.

AVOIDING WEAK LINKS

Torn cartilage in the knee or a stress fracture can harm you, whereas a bruise and a small hematoma (swelling) from a kick will merely hurt. A certain degree of hurt is okay--it's the harm you have to watch out for.

The danger of letting "hurt" continue until it causes harm is that, even when the injury can be "repaired," it often leaves you with a structural flaw, a weak link--like Jose Reyes's scarred hamstring--that makes you vulnerable to further injury.

We all have these vulnerabilities in our frames: structural flaws, some big, some small. Some are obvious and/or symptomatic--others quiet, asymptomatic, lurking beneath the skin, waiting for the right circumstance to rear their ugly heads. Many stay quiet for a lifetime but all have the potential to give you grief.

Weak links come in many varieties and can be from:

An old injury or ailment that leaves a structural flaw

Imbalances in musculature or flexibility that put stress on particular joints

Incomplete rehabilitation of an old or new injury or ailment

Alignment or anatomy problems

Genetics

Tissue changes resulting from aging or other causes

Your mindset or attitude

Your program design or exercise technique

Many injuries do not completely rehabilitate, something we call IRS, or incomplete rehabilitation syndrome. It takes a lot of work to get back to 100 percent (or as close as possible) after an injury, and most of us stop around 80 to 85 percent when our bodies think they feel okay (i.e., when the swelling is down and the limp goes away). This is a big mistake. Playing at 80 percent often means reinjury.

Likewise, imbalances in strength, flexibility, or both can be a major setup for bone and joint problems. Most of us are at least a little out of balance, which is why your alignment, genetic makeup, or changes that occur from aging also create vulnerabilities in your frame. The weak links that upset me perhaps the most, and are probably the most preventable, are those we inflict upon ourselves with a negative mindset or poorly designed workouts. The importance of all this is that a chain, or should I say your frame, is only as strong as its weakest link. Find those weak links and toughen them, and you are ready to go the distance.

You have to construct your exercise program to work around, or through, your own, distinctive weak links. By my estimation, 80 percent of the adult population needs some degree of customization of their exercise programs to accommodate their weak links. In the self-test in Chapter 4, I'll help you identify your weak links. Then in the exercise routines, I'll show you how to work around them.

YOUR CHEATIN' BOD

Once again, with any form of exercise, you're sculpting your frame for good or ill. The more you do, the more it pays to do it right and make your exercise specific to your objective. But as we develop weak links, our bodies try to find the easy way out, which does not help the cause.

I once saw the legendary Rudolf Nureyev dance on a night when I could tell that his foot was really bothering him. This was at the Academy of Music in Philadelphia, and after the curtain I went backstage where he asked for my advice. He told me he was worried about a "student of his" who was having trouble with an arthritic great toe--a significant problem for someone who jumps for a living. As we talked further and established a bit of trust, eventually he confessed that the dancer with the toe problem was himself.

Of course, I knew that--I'd been watching him all evening trying to compensate for that painful foot.

A master like Nureyev has a thousand tricks to distract your eye from the problem area, but whenever someone has an injury or imbalance, the body tries to pull off the same magic act. It happens so subtly that usually we're not even aware of it. The body starts cheating a little, and compensating a lot, until all the cheating and compensating create a huge problem.

Dancers who don't have a natural hip turnout, who force their turnout, try to compensate. They rotate the shin around more so that the knee and foot is what is turning out, when the turnout should come at the hip. The knee twist that some use to compensate wreaks havoc. A dancer can rotate her foot around and can drop and destroy her arch and midfoot area, create a bunion, or even damage tendons around the ankle.

The body finds a way, even when you're not conscious of it, and it can happen in almost any sport or fitness activity.

A painful or impinged bone in the foot can throw off your gait, which can throw out your lower back. Loss of range of motion in your shoulder can cause distortion, not just in your golf or tennis swing, but in the musculature all across your upper torso. Favoring your right knee can cause you to sprain your left ankle. It can also cause your right quadriceps to shrink in circumference by an inch or two.

This is why mindfulness in your exercise becomes so important, because all too often, you think you are doing the right thing, but your body is cheating and compensating all of your muscles. When people have had a knee injury or kneecap pain, and they do leg lifts to strengthen the quad muscles, they don't get the benefit because their body cheats, using the hip to lift the leg rather than the important quadriceps muscle.

That's why, in this book, I'll show you modifications to prevent you from cheating your body. For example, if you have knee pain while doing simple leg lifts, I'll teach you the modification called "lock and lifts." For people coming off surgery or kneecap pain, it's a smart, effective way to strengthen the thigh without irritating the kneecap.