KineSophy

KineSophy

Thursday, January 14, 2016

Physical Possibility

Joy Johnson - photograph by The New York Times
“People always ask me why I run. Each run I took every single day was guaranteed to be different. For all those years, all those days began with the most beautiful thing in the world. Possibility. It sounds simple I know, but trust me, it is the very best part of being alive. Never knowing what the next step will bring.” - Joy Johnson

From 1989 through 2013, Johnson completed twenty-five consecutive New York Marathons, the last one at age eighty-six. She fell during the race and sustained some cuts to the side of her face, but finished and made her annual visit to The Today Show the following morning. She then returned to her hotel room, feel asleep and never woke up.

Anyone who bought a Powerball ticket in the past week can empathize with Joy Johnson. Knowing the astronomical odds, I doubt most people truly expected to win. But they were entranced by the dream of possibility.

When Johnson first took up running at the age of fifty-nine, she discovered a whole new realm of possibility. We face possibility every day. Sometimes, it's what gets us out of bed in the morning. And living a physically active life opens up an entirely new set of possibilities. We can engage the opportunity to run faster, hike farther, balance longer or lift heavier. That's not to say that physical possibilities are more important than mental, emotional or interpersonal possibilities. But if there's any truth to Johnson's words, it makes sense to explore possibility in all its manifestations, and to make our next step the most beautiful thing in the world.

Friday, January 1, 2016

Thinking Critically About Push-Ups

            Regular practitioners of yoga are familiar with the transition from plank pose to chaturanga, or low plank, in which the yogi mimics the downward phase of a push-up by lowering herself from a support on her hands and feet with straight arms to a support on hands and feet with bent arms, all while maintaining a straight body line from head to heel. In chaturanga, the upper arms should be parallel to the floor, with the shoulders no lower than the elbows. I have heard multiple yoga teachers warn students not to descend below this point, because doing so runs the risk of shoulder injury. Some personal trainers and fitness instructors also recommend limiting push-up range of motion to a ninety degree bend in the elbows. This restriction always struck me as odd. While not supporting my body’s weight, I can easily pull my elbows back past my torso and bring my hands alongside my chest without any injury or discomfort, despite the fact that I am hardly the most flexible person around. Considering this mobility alone, I should be able to touch my chest to the ground while doing a push-up without my shoulders exploding. And it would seem reasonable that I should be able to perform a simple functional movement like lying face down or getting up from the ground without injury. So those who encourage a restricted push-up must believe that this full range of motion cannot hold up to some amount of weight, a weight exceeded by that of my body. Yet by that logic, if I was lying face down on the ground and wanted to get up by pushing with my arms, it would be dangerous for me to do so unless I first raised my shoulders above my elbows. So what gives?
            A perusal of some online yoga sources yields multiple warnings but little rationale. A description of chaturanga on the website Yoga Outlet warns, “Do not let your shoulders drop below the height of your elbows. It’s better for your shoulders to be too high in the pose than too low.”[1] This statement begs the question, “better how?” What about lowering your shoulders below your elbows makes this a worse position? And how does it do so? Even Wikipedia chimes in, warning, “Don't sink your torso below the elbow level [in chaturanga] because this puts a lot of pressure on the elbow joints.”[2] Interestingly, the Wikipedia article on push-ups mentions nothing about the dangers of elbow pressure.[3] And how much pressure does sinking below ninety degrees deliver to the elbows? Simply setting up for a push-up with straight arms puts pressure on your hands and feet because of the weight of your body. At what point in the push-up does this pressure become “a lot?” Is a lot of pressure more than your elbows can handle? And how were these pressures and pressure thresholds measured? Neither article offers anything in the way of justification.
            Now it’s perfectly reasonable to allow a movement practice like yoga to define the scope of its movements. If the original yogis decided that chaturanga should terminate with the torso and shoulders even with the elbows, I am in no position to argue that the movement should continue beyond this point without knowing the original rationale. It’s quite possible that the first yogis preferred the aesthetic appearance of multiple right angles over having one’s elbows stick up like a pair of dorsal fins. Or perhaps, in the centuries before cushy Lululemon mats, yogis opted against lying face down in the dirt every time they did a Sun Salutation. Yet while yogis might have had many reasons for defining chaturanga as they did, it is misleading to claim that we should limit the movement for fear of some undocumented injury risk.


            Similar claims appear in the sphere of personal training and fitness coaching. “Very rarely should a person go that low [touching the chest to the floor] in a push-up,” Zach Moore claims on the website of Indianapolis Fitness and Sports Training. “In fact,” he continues, “trying to touch your chest to the floor will put your shoulder joint in a bad position.”[4] This claim suggests that extending your shoulder by about forty-five degrees, whether in a push-up or not, is a bad position. Yet such motion seems well within the range of normal shoulder mobility. Moore attempts a further explanation: 
 “In a push-up, and really all exercises, we want our humerus (upper arm bone) centered in the socket… The shoulder blades will actually come together in the bottom of a proper push-up, and this is actually the ideal stopping position. So when your shoulder blades are retracted (squeezed together) that is when you should push back up. If you try to go beyond this point then the arm bone will continue to move while the shoulder blade and socket are fairly stationary. Therefore, the arm bone will not be centered in the socket.”[5]
Again, we should ask what evidence exists in support of these claims, which don’t appear in many other resources analyzing the push-up. Why should the humerus remain centered in the shoulder socket? And even if it should, perhaps the end goal should be to acquire enough scapular mobility to get off the ground from a prone position rather than declaring this position flat-out unsafe.
            Normal shoulder extension (moving your upper arm behind the vertical plane of your torso) is sixty degrees. Normal elbow flexion (bending your elbow) is 150 degrees.[6] I need about forty-five degrees of shoulder extension and 135 degrees of elbow flexion to reach the bottom of a push-up with my chest on the ground and my forearms vertical. Individuals with longer upper arms or forearms than me will require greater mobility. But I imagine most people will be able to achieve a full depth push-up without greater than normal shoulder or elbow mobility. Based on range of motion alone, there is no evidence to indicate that no one should lower their shoulders below their elbows.
            Most physical therapists appear to support performing push-ups through a complete range of motion. Though we should not necessarily accept their word without supporting evidence as absolute truth, the general agreement of professionals responsible for preventing and rehabilitating injury should carry some weight. A video on the Tensegrity Physical Therapy website shows a demonstration of a push-up with the actor’s chest touching the floor.[7] In an article endorsed and published on the website of physical therapist Dr. John Rusin, personal trainer Meghan Callaway writes, “At the bottom of the push-up, the elbows should bend to 90 degrees, although going to a greater depth is good if proper form can be maintained, and if the body feels good.”[8] Physical therapist Kelly Starrett demonstrates a push-up to the ground in another video. Starrett further emphasizes the importance of maintaining a neutral spine and externally rotated shoulders (pointing your elbow creases forward) while performing a push-up in order to keep the humerus from traveling forward in the socket, which helps clarify Moore’s warning about excessive humerus movement. If both Moore and Starrett are correct, performing a full depth push-up is safe, provided the movement is performed correctly.
You’ll notice if you descend through a push-up that more strength is required the closer you get to the ground. It’s not that difficult to complete the top 1% or 5% of a push-up, when all you have to do is straighten your elbows to finish the movement. But you’ll notice that it is much more difficult to move 1% or 5% upward once you’ve bottomed out on the ground. Because the bottom of a push-up is more challenging than the top, there is a greater chance that your form will break at the bottom, making you more susceptible to injury in this position. Yet it would be erroneous to use this logic to claim that the bottom position is patently unsafe. Driving fifty-five miles per hour on an expressway in normal traffic is, generally speaking, perfectly safe. However, it would be unsafe for a fifteen-year-old driver to do so the first time he gets behind the wheel. We practice driving so that we can do so competently within the legal boundaries. We practice moving so that we can do so competently within the biomechanics of our bodies.
So while yoga as a movement practice is free to define chaturanga and other movements however it wants, today’s yoga instructors should not claim that deviation from that definition is cause for injury, especially if the human body is fully capable of going beyond the defined parameters of the movement and there is no evidence to support claims of potential injury. Like most activities, performing a chaturanga or push-up is a matter of personal responsibility. Lowering one’s body to the ground and standing up from a prone position are basic functional movements, the mobility and strength to perform them safely are not superhuman, and I see no evidence that these movements are especially dangerous for those with healthy joint function. It would seem that those who claim otherwise have not paused to think critically about this movement.






[1] “How to Do Chaturanga in Yoga.” Yoga Outlet. Online. 20 Dec. 2015. http://www.yogaoutlet.com/guides/how-to-do-chaturanga-in-yoga.
[2] “Chaturanga Dandasana.” Wikipedia. 15 Dec. 2015. Online. 20 Dec. 2015. https://en.wikipedia.org/wiki/Chaturanga_Dandasana.
[3] “Push-up.” Wikipedia. 17 Dec. 2015. Online. 24 Dec. 2015. https://en.wikipedia.org/wiki/Push-up.
[4] Moore, Zach. “How Low Should You Go in a Push-Up?” Indianapolis Fitness and Sports Training. 11 Dec. 2015. Online. 20 Dec. 2015. http://indianapolisfitnessandsportstraining.com/how-low-should-you-go-in-a-push-up.
[5] Ibid.
[6] McAtee, Robert E. and Charland, Jeff. Facilitated Stretching, Third Edition. Champaign, Illinois: Human Kinetics, 2007.
[7] “Push-up Plus.” Tensegrity Physical Therapy. Online. 21 Dec. 2015. http://tensegrityphysicaltherapy.com/exercises/upper-extremity-strength/push-up-plus/.
[8] Callaway, Meghan. “The Lost Art of The Push-Up, It’s Many Variations & Functions.” Dr. John Rusin. Online. 21 Dec. 2015. http://drjohnrusin.com/the-lost-art-of-the-push-up-and-its-many-variations-and-functions