How Many Repetitions Are Enough?

Clients often ask me how many times they should be doing an exercise to build strength. Often they are coming from a more-is-better place - the gym - and they are confused.

I don’t always feel comfortable answering that question, either. How many repetitions of an exercise are fine may well depend on what the point of the exercise is – strength? size? flexibility? What about function? If the muscle is a core muscle, does that change the formula as opposed to those muscles we like to see flexing in the mirror?

And what do I, as a massage therapist, really know about exercise? Do I need a course in physical exercise to answer that question? What if I say something different or conflicting from what the trainer says?

I would like to know how other massage therapists handle this question.

Of course, in the meantime, I’ll give you an idea of how I handle that question. I touch people all day, and I get a feel for muscle health in terms of its aerobic state, lymph circulation, and flexibility. Over the years I have learned to trust my hands when they tell me something. I know that granular, adhesed muscles won’t stretch or exercise very well.

After some massages and stretching, they may be ready to perform. The nervous system, truly, is in charge. If the parasympathetic system is not engaged, change is not about to take place.

If that sounds like a massage therapist’s answer to another massage therapist, it is. And it’s way too complicated for clients. I usually go simple and easy.

I tell clients like to do three slow, pain-free repetitions. Three isn’t many, but I say three because everyone ignores the slow, pain-free parts. If those reps go okay, then I’ll do something else and then do another set of three. Three reps, three sets.

That is a lot less than the standard gym advice of three sets of fifteen, done in succession. It’s so way off from what most people are told that it does get their attention.

For me the bottom line is that muscles need to be relaxed and pain-free to exercise in a healthy way. If something is too tight or hurts to move, the body will protect it by substituting another muscle or group, or the muscle will be injured. Repetitions that feel good generally are going to help. Wobbly, strained, borderline-painful repetitions are going to make problems worse.

Sometimes the biggest change I can get from people is to stop instead of pushing through a pain. Shoving through pain only works if you are in the NFL. They have a good pension plan.

Cheeky Little Ligament!

Being my alter ego as I often am, Superwoman, I hate to admit I went "Wii!" -- and Wii!-ed myself right into a lot of pain.

Yes, there are lots of warnings on the box, and yes, I am not 16 anymore. But it was so much fun hitting fake homeruns and beating the girls at bowling, I didn’t stop, warm up, hydrate or anything else.

Next morning, I had some serious fun trying to do massages.

It felt like something between a groin pull, a hamstring pull and a possibly serious symptom of visceral disease in the pudendal area. The act of sitting down hurt. Sitting hurt. Standing hurt. It hurt to touch the gas pedal. It hurt to move my foot to the brake. It hurt to lie in bed. It hurt to toddle off to the bathroom. It DEFINITELY hurt to use my feet to push during a massage!

That night I spent a few hours soaking in Epsom salts, trying to treat myself. The groin was painful, but the adductor magnus, gracilis, and the hamstrings were at my “normal” length. The piriformis wasn’t sore, nor were the glutes or low back. Psoas had my normal range. Puzzled, I slathered Epsom lotion on the medial thigh for the overnight cure: eight hours of sleep.

Next day I was no better, if not a little worse. Lately my massage trading buddy and I had been too busy for our weekly trade. Now I begged for some table time.

My trading buddy, who thought my predicament moderately hilarious, had me go prone on the table. Some palpation of the sacrum, the hammies and pretty soon he had found where the pain lived. In the inside lower cheek, just above the leg and next to the gluteal fold. He gently pressed the area, and I felt the pain flood my groin.

“Aha! The sacrous-spinal ligament!” he said. “That recreates the pain!” I said.

After about 10 minutes of trying to remember the name of the muscle also possibly involved – go-gos, Gemmullus? Obturator? – we are both kind of old hands – he called it out – quadratus femoris!

“Forcible lateral rotation of the foot!” he said. Sounded like Wii bowling to me. Somehow when putting some extra English on one of those bowling ball deliveries I’d managed to nail the right foot into forcible external rotation – and I had missed guessing at the cause by a mile. It wasn’t a groin injury at all.

Later that evening, with some relief finally setting in, I checked the internet and found some interesting citations. First, I found a paper on surgical decompression of the ligament in a woman with a long history of intractable sciatica. Lo and behold, the sciatic nerve toodles right on by that the sacrous-spinal ligament and the quadratic femoris, and might just be really annoyed by sudden torsion or injury. Another citation fingered the ligament as a cause of pudendal pain in women. Another paper blamed the sacrous-spinal ligament as culprit in people who have symptoms of disc disease, but don’t have any findings upon X-ray.

As they say in professional wrestling, school was out. With 15 years beside the massage table, I had yet another epiphany about the body, it’s complicated anatomy and my own enthusiasm for winning at any cost. Yes, I too have Gung-Ho Disease.

Lessons learned:
1. Don’t expect to be able to spot the problem when treating yourself.
2. No slacking on the weekly massage schedule.
3. Leave the Wii! world championships to people who are less competitive and more flexible.

Walk, Walk, Walk

This morning when I was helping my friend Margaret move some furniture around her house, I almost stumbled over a pair of dusty aerobics steps. “Hey,” I said, “I think Leslie has some of these things, but hers are inclined, so you don’t really have to step up, just slightly up and out.” Margaret found this extremely amusing: “Leslie this, Leslie that, Leslie says . . . you’d think you guys were really close.” “Well we are,” I said stubbornly, but laughing along with her. “She told me this morning how glad she was that I took time for myself today.” Leslie, you see, is not actually a “friend” I know to talk too; in fact, she wouldn’t know me from Eve. Leslie is Leslie Sansone, and she and I walk together three or four times a week in my living room.

I really hated exercise growing up. Exercise was not fun. It was used as punishment (go run around outside: you read too much); as humiliation (middle school P.E.: anyone for a friendly game of War?); and most importantly as prevention for, GASP!, “getting fat” (go ride your bike or you’ll grow up and get fat and no one will want to take you to dances and such). Now that I’m older, I still see how much torture and guilt exercise generates for the normal person, and it makes me sick. And it literally makes some clients sick, especially when they get struck by guilt, and—being out-of-shape—overwork themselves in the gym. So generally, I’m big on recommending swimming because it’s such good movement with so much less stress on the joints, etc. And of course, water aerobics is just mad fun. The only part I personally hate about swimming is either having to have clothes to change into, or driving home in a damp swimsuit, especially in this climate.

I also love walking, but moving to Seattle fixed that for me. To be fair, walking in Arkansas can be miserable in the in the summer, but at least you have long evenings and a cool-down at dusk where walking can be enjoyable. But no matter what the season in Seattle, rain is rain, and here it’s cold rain to the bone and all kinds of lovely gray things to look at on your promenade. Still, I realized this summer that I needed to move my body for my body’s sake, so I needed to look for something that I could do that I could both enjoy and keep up with. Leslie Sansone’s Walk Away the Pounds book caught my eye, and even though I wanted to walk-in the health benefits more than the walk-away-the-pounds benefit, I fell in love with this six-week, journal-based, down-to-earth program and the normal, positive-but-not-freaky, non-anorexic, woman-next-door-type guru who invented it.

I bought my book at our local Fred Meyer, and although I could order dvds from Leslie’s http://www.walkathome.com/, I usually get them at about a third of the cost from discount dvd websites. Frankly, I don’t think Leslie would be hurt that I purchased my dvds from another seller; as weird as it sounds, I think she really means it when she says the important thing is to do something good for yourself and “just stay in motion.” She’s client -based, and so am I, so I think I trust her more than some of these other work-out girls. Here are a few other reasons I like the Leslie Sansone Walk At Home Program so much:

1. She looks like an attractive 40-something woman. Which she is. She does not look like a plastic surgeon’s fantasy project who secretly wants to look 20 again. In other words, “regular’ people can relate to her.

2. She talks like a normal person. She has her own unpasteurized dialect, and if she’s nearly choking on the word walk (how many times can you say it while walking without needing a serious drink of water?), she never shows it.

3. She’s encouraging, but not preachy. She seems honestly more centered on health than just weight.

4. She doesn’t try to be a diet idiot: she sticks to what she knows.

5. She doesn’t try to sell you a bunch of useless crap; have good shoes, can walk.

6. Her materials are true to their levels. Beginner is beginner and advanced is advanced.

7. She isn’t lying; not only did my heart perform better in testing after her program, but we did all my measurements before and after, and I did indeed lose an average of 2.25 inches all-around.

I now can add Leslie’s Walk At Home program to my exercise recommendation list, and I feel really good about that. I know that my clients cannot hurt themselves doing it, especially since she regularly tells walkers to “slow down at any time” because “as long as you stay in motion, you’re doing something good for your body.” My only complaint would be that I prefer her solo dvds to the ones where she walks with a group of people. Why? Because she talks to them a lot instead of talking only to me, and frankly, that makes me jealous. My Leslie. Maybe I am getting a little too attached? Oh, well. Daily exercise is finally fun, and I feel I owe a debt of gratitude :-)

Seven Secrets THEY Don’t Want You to Know

My client, a teacher-in-training, was astonished when her fellow students ignored her first practice teaching class.

Her collegial group huddled over their laptops, tracking a package on UPS, reading e-mails, even one was applying to a competing college’s credential program.

Her carefully crafted first lesson was treated like a slow fly on a hot day.

She was dumbfounded, to say the least. What would happen if they had to put up with that behavior during their own first turn around the track, she asked. Could they at least pretend to be interested? How would they like to be treated like Charlie Brown’s teacher?

I sympathize, I empathize. In my own massage practice I had run into clients who don’t listen, employees who hated the least little coaching.

Ever helpful, I volunteered an idea. You know that guy who makes people pay for the chance to find out how they can power up themselves personally? They get to walk on coals and find their true destiny? Perhaps what we need is that marketing hook for all lesson plans.

Should learning be packaged like soap, electronics and political opinions? Can a shouting commercial pitchman make people pay attention? Order now and I’ll double this offer!

Well, aren’t people supposed to multi-task these days? Sure, we all do. But her cognitive learning course was basically saying that if people can’t focus and listen they can not learn.

Perhaps a good hook is what they need. Instead of cognitive learning 201, try:

“Trick Your Students into Testing Well”

“Five Principles of Successful Vice Principals”

“Teach Algebra While you Text!”

“Get a Teaching Credential Just for Showing Up!”

Taken to its logical thread – yes I do have one - how about marketing hooks for those folks on our tables?

“Never Have a Headache Again!”

“Feel 20 Years Younger without Getting a Divorce!”

“Look to the Left without Pain!”

“Discover Your Personal Power Ranger Within!”


Well, it was good for a few laughs. Perhaps it might make a good e-book.