Low Back Pain: Get Started with Abdominal Exercises

Low back injuries usually do not occur from one single incident or event like lifting a heavy box.  Instead, most back injuries occur from small incremental stress or load applied over time.  Sitting slouched for prolonged periods at a desk or repeatedly performing bending and twisting can overload sensitive spinal structures.  These structures include the muscles, facet joints, ligaments, discs, and nerves.   Muscle weakness, poor endurance, poor position awareness, and previous history of injury can make one more susceptible to low back injuries.  Most of these injuries are not serious and do not require extensive testing or treatment.

The core muscles function to spare the lumbar spine and surrounding structures from excessive load.  These muscles include the abdominals, low back musculature, diaphragm, and pelvic floor muscles.  No single muscle is more important than the others.  Human movement and low back pain are more complex than one muscle or structure.  Instead, all muscles should ideally function together in coordination.  Pain interferes with coordination and control.  The specific task being performed determines the magnitude and timing of core muscle activity.  Some tasks require a very low load and level of muscle activity such as bending to tie the shoes.  Other tasks require greater muscle activation patterns at high speeds such as swinging a baseball bat.

Exercises to train the core musculature should begin with low loads focusing on control and endurance.  Exercises performed lying on the back targeting the abdominal muscles is a great place to start.  The following exercises can be performed by those with low back pain or those with a history of back pain looking to prevent recurrences.  Once these exercises are no longer challenging, progression is needed.  Future articles will address proper progressions.

Abdominal Bracing

Begin lying on your back with the hips and knees bent.  Find a neutral spine position by gently rocking your pelvis back and forth.  Your neutral position is somewhere between a fully arched and fully flattened position.  In your neutral position, you should be able to hold a small grape under your low back without crushing it.  Maintain a neutral spine and gently contract your abdominal muscles in the front and sides continuing 360 degrees around to the low back.  This muscle contraction should be gentle and no movement should occur.

Once a neutral spine can be maintained with gentle bracing, breathing is added.  Diaphragmatic breathing is performed while maintaining a neutral spine and gentle bracing.  This involves expanding through the belly and rib cage in a 360-degree fashion.  Minimal or no movement occurs in the upper chest and shoulders.  Five deep slow breathes are performed while maintaining a neutral spine and bracing.  No breath holding or movement of the spine should occur.  It is helpful to place one hand on the abdomen and the other hand on the chest to ensure a proper breathing pattern is maintained.   This exercise forms the foundation for all subsequent abdominal exercise progression to follow.

Bent Knee Fall Out

The bent knee fall out is performed after abdominal bracing and diaphragmatic breathing have been mastered.  Begin with a neutral spine, bracing, and diaphragmatic breathing.   Lower one knee to the side towards the floor in a slow and controlled fashion.  No movement in the spine or hips should occur.  It is helpful to place the hands on the hip bones to ensure no movement is taking place.  With each repetition alternate sides.  To increase the challenges add a resistance band around the thighs.  Perform 10 slow repetitions on each side.

90/90 March

This exercise begins with a neutral spine, bracing, and diaphragmatic breathing.   Elevate the legs so the hips and knees are at right angles.  Maintain a neutral spine, bracing, and proper breathing as you slowly alternate lowering the heels to the floor.  Gently touch the heel to the floor without relaxing.   Perform 10 slow repetitions on each side.

Heel Hover

Begin with a neutral spine, bracing, and diaphragmatic breathing.   Elevate the legs so the hips and knees are at right angles.  Maintain a neutral spine, bracing, and proper breathing as you slowly alternate extending of the knee so one leg straightens without touching down.  As you lower the legs, it is important that the low back does not arch away from the floor.  Perform 10 slow repetitions on each side.

Double Leg Lift

Begin with a neutral spine, bracing, and diaphragmatic breathing.   Both knees and feet are then simultaneously elevated so the hips and knees are at right angles.  Maintain a neutral spine, bracing, and proper breathing as you slowly lower the legs together.  Do not touch down or relax the feet to the floor.  It is important that the low back does not arch away from the floor.  Perform 10 to 20 slow repetitions on each side.  To increase the challenges add a small ball to squeeze between the thighs.

Closing Thoughts on Abdominal Exercise for Low Back Pain

Pain interferes with how our brain transmits signals to our muscles.  This is especially important when your low back pain has persisted for more than several weeks.  These 5 abdominal exercises re-program the lost connections between the brain and core muscles.  Slow coordinated and controlled movements are crucial for success.  Absolutely no holding of the breath should occur.  Breathe holding increases tension throughout the body and interferes with retraining of the muscles and nervous system.   Practice these exercises, master them, and improve your endurance by increasing repetitions.   Once these goals are achieved, you are ready to build strength and resilience with more challenging exercises.

Tips for improving your chances of success in physical therapy

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Gluteus Maximus Exercise: Training in Multiple Planes

The gluteus maximus is the most powerful hip extensor.  This is important for functional activities performed in one plane such as walking, running, and climbing stairs.  However, this muscle also has important functions outside of straight ahead planes of movement.  The gluteus maximus also helps control balance and generate power in other planes.  Rotational and lateral movements in everyday life and sport require important contributions from the gluteus maximus.

Training the gluteus maximus should incorporate single-plane hip extension exercises and exercises in multiple planes.  Single-plane exercises such as the squat and hip hinge do not fully develop the glutes.  Training programs should also include exercises with rotation of the trunk or lower body on one leg.  These types of exercises prepare athletes for changes or direction, throwing, and jumping from one leg.   Performance improvements and reduced risk for injury often occur with long-term training in multiple planes.  The five exercises included in this article are only examples.  Many other exercises can be adapted to train the entire body with rotational movements.

Crossover Step Up

The crossover step up helps expose and improve any side to side difference in gluteus maximus strength.  Stand to the side with your left leg next to an elevated step or box.  Cross your right foot in front and step up onto the box.  Keep your hips square throughout the exercise.  Next, cross your right foot behind the left while stepping down to briefly touch the floor on the opposite side.  When descending think about sitting back into the hips.   Reverse the movement in the opposite direction.  Perform the exercise slowly with control.   The challenge of the exercise can be increased by holding a dumbbell or kettle bell in the hands or close to the chest.

1-Leg RDL

The single-leg Romanian dead lift (RDL) is a single-leg exercises which requires stabilization of the trunk on the lower limb in multiple planes.  These exercise begins by standing on one leg with the opposite hip and knee extended.  The weight bearing knee can be slightly bent throughout the exercise.   Initiate the movement by slowly flexing at the hip, keeping the back straight.  The non-weight bearing leg extends straight back behind the body.  Both the descending and ascending parts of the exercise should be performed in a slow and controlled manner.   Also, maintain control and the position of the weight bearing leg during the exercise.   Perform 8-10 repetitions on one leg before switching sides.   The challenge of the exercise can be increased by holding a dumbbell or kettle bell in the hand on the side of the swinging leg.

Transverse Lunge

The transverse lunge starts standing with the feet near each other and hands on the hips.  Throughout the exercise the trunk is maintained in an upright position, so the knee and hip of the lunging leg can be flexed to 90°. This prevents the knee from moving forward past the toes.  Also, the knee remains over the toes so it does not cave inwards into valgus.  During the transverse lunge, the body is rotated 135° towards the lunging side.  This involves twisting behind the body and lunging in one motion.  Add load by holding a dumbbell or kettlebell in the hand opposite the lunging leg or against the chest.  This exercise shows high activation of both the gluteus maximus and gluteus medius.

Skater Squat

The skater squat introduces rotation of the trunk on the lower limb.  The exercise begins by standing on one leg and performing a squat to a comfortable depth.  The depth is determined by the ability to maintain balance and good control of the trunk and entire lower extremity.  The non-weight bearing leg extends at the hip and flexes at the knee. The torso slightly rotates and the arms swing reciprocally as if skating.  The toe of the non-weight bearing leg can touch the floor between repetitions if needed.  Hold the downward position for 2 seconds then return to the starting position.  Add load by placing a resistance band around the thighs just above the knees.

Rotational 1-Leg Squat

 The rotational 1-leg squat is a progression of the skater squat.  Both exercises have a rotational component to the squat.  This exercise further challenges the balance and stability of the hip.  Begin by balancing on one leg holding a medicine ball in both hands.  The non-weight bearing knee and hip flex to approximately 30°. Slowly lower toward the floor being sure to maintain control of the trunk and supporting leg.  The depth of the squat is determined by the ability to maintain balance and control the movement.  Rotate the hands and medicine ball upwards and towards the weight bearing leg as you perform the squat.  Return to the starting position and keep the knees over the toes to prevent knee valgus throughout the exercise.

Glutues Maximus Exercise: Closing Thoughts

Gluteus maximus weakness is common in those with chronic back pain, hip bursitis, hip arthritis, knee arthritis, and runner’s knee (patellofemoral pain).  Training the glutes primary function of hip extension is important but often not enough for most demands of sport and everyday life.  These five exercises are challenging and not for everyone.  If you are unable to maintain balance and stability on one leg try other exercises first (basic gluteus maximus exercises).   If you are still unsure how to start, contact your physical therapist for help.

 

Gluteus Medius Exercise Progressions

The primary role of the gluteus medius is to stabilize and control movement of the pelvis during weight bearing functional activities.  This is required for efficient walking, climbing stairs, running, jumping, and throwing.  All of these activities require at least a brief period of single leg support.  The gluteus medius maintains a level pelvis and prevents the opposite side from dropping.  Without adequate functioning of this muscle, balance, strength, power, and performance will be compromised.  Also, abnormal movement patterns, such as dynamic valgus, occur in the presence of inadequate gluteus medius function.

It is advantageous to progress exercises for the gluteus medius from non-weight bearing to standing positions.  The exercises included in this article are 5 options but there are many others.  The most important aspect of these exercises is that they performed in a slow and controlled manner with appropriate body alignment.   The emphasis should first be on proper technique before adding repetitions or resistance.

Band Hip Abduction

Band hip abduction is performed with an elastic band tied around the ankles standing in an upright position with the feet together.   The feet are then pulled slightly apart.  Stand on one leg while keeping the pelvis level.  Abduct the other leg about 25° while maintaining the trunk in an upright position.  The most common mistake is to abduct too far and tip the body to the other side.  It is also important to keep the toes pointing straight ahead throughout the exercise.  Tension should be maintained on the band so the feet do not touch.  Both the supporting and moving side gluteus medius are very active during this exercise but the standing leg receives the greater training effect.

Band Internal & External Rotation (IR/ER)

Band IR/ER is performed with an elastic band tied around thighs (just above the knees) standing in an upright position with the feet together.  Once the band is in place, separate the feet to shoulder width or slightly wider.   During the exercise the knees and hips are flexed about 30°.  The hands are placed on the hips.  Initiate the movement by slowly moving one knee inwards over a 2 second period.  Maintain the position of the opposite knee.  Then slowly pull the knee outwards over a 2 second period.   Perform 8 repetitions in a slow and controlled manner on one side before switching to the other leg.

Lateral Band Walk

The lateral band walk is performed with an elastic band tied around the ankles standing in an upright position with the feet together.  During the exercise the knees and hips are flexed about 30°.   The hands are placed on the hips.   Sidestepping is initiated by leading with one leg over a distance slightly wider than shoulder width.  It is important to keep the toes pointing straight ahead and the knees over the toes throughout the exercise.  Tension should be maintained on the band so the feet do not touch.  Three slow steps are performed in one direction followed by 3 steps in the opposite direction.  Each cycle constitutes 1 repetition.  Typically, 6-8 repetitions are performed each set.   To increase the challenge of this exercise, two bands can be used.  A second band can be placed above the knees.

Dynamic Leg Swing

The dynamic leg swing begins by standing on one leg with the opposite knee flexed to 90 degrees.  Initiate the movement by swinging the non-weight bearing leg (with the knee flexed).  Move into hip flexion and extension at a rate of 1 second forward and one second backward.   Move through a smooth range of hip motion and do not allow the trunk to move out of the upright position.  Also, maintain control of the position of the weight bearing leg during the exercise.   Perform the 8-10 repetitions on one leg before switching sides.   The challenge of the exercise can be increased by holding a dumbbell or kettle bell in the hand on the side of the swinging leg.

1-Leg RDL

The single-leg Romanian dead lift begins by standing on one leg with the opposite hip and knee extended.  The weight bearing knee can be slightly bent throughout the exercise.   Initiate the movement by slowly flexing at the hip, keeping the back straight.  The non-weight bearing leg extends straight back behind the body.  Both the descending and ascending parts of the exercise should be performed in a slow and controlled manner.   Also, maintain control and the position of the weight bearing leg during the exercise.   Perform the 8-10 repetitions on one leg before switching sides.   The challenge of the exercise can be increased by holding a dumbbell or kettle bell in the hand on the side of the swinging leg.

Closing Thoughts

These 5 exercises can be used as a standalone program for improving gluteus medius activation and strength.  However, all 5 exercises do not need to be performed.  Choose 2-3 exercises to perform 3 days per week.  These exercises are also ideal for athletes and exercise enthusiasts to incorporate into their warm-up routines.  Specifically, try 2 or 3 of these exercises prior to performing compound lifts such as the squat or dead lift.   Next week we’ll highlight some more advanced progressions to load the gluteus medius.  If you any further questions, give your physical therapist a call.

 

 

Self-Management of Pain: Your Physical Therapist as a Guide

Too many medical approaches in today’s society are dependent on others (therapists, doctors, etc) and include passive treatments (medications, injections, etc.).  It can be empowering to take control of your own health and seek active forms of treatment for conditions such as low back pain, arthritis, or even every day sprains and strains.  Self-management allows you to develop a sense of control over your problem and offer you tools to use for a lifetime.  However, many are unsure where to start.

Therapeutic Alliance and Self-Management of Pain

In order to optimize self-management for any painful condition, a meaningful working relationship, or therapeutic alliance, in which the patient and provider work together, should be established.  This begins by developing a patient-preferred approach to treatment.  If you prefer to exercise aerobically then you should not be forced to perform lumbar stabilization exercises for your back pain.  If you enjoy strength training in the gym you should not be prescribed aerobic exercise for your knee pain.  Exercise you enjoy is medicine for the body and mind.  Both forms of exercise have been shown to be beneficial for managing back pain.  Let’s choose together what you prefer.

Developing a positive therapeutic alliance with your physical therapist also allows for the careful monitoring of progress over time.  There are going to ups and downs along the way.  Your physical therapist can help pick you up during challenging times.  Your physical therapist can also progress your plan appropriately when things are going well.  A physical therapist can work as a coach offering constructive feedback and encouragement.   They can help you make periodic adjustments to your self-management program.  With this approach, you are in control of your own health and your therapist acts only as a guide.

The interaction between you and your health care provider has been shown to be one of the strongest predictors of patient satisfaction with physical therapy care, and a key contributor to a successful outcome.  Research shows the amount and quality of the interaction between a patient and their physical therapist has a profound impact for those with persistent back pain.  Taking advantage of these positive interactions will magnify the effects of any exercise program or lifestyle modification. Having the same therapist, will potentially enhance the therapeutic alliance, guide you towards your preferred self-management strategies, and help you achieve the best possible long-term outcome.

What Self-Management Looks Like

Your physical therapist will first seek to understand your beliefs about pain and your condition.  Many people hold negative beliefs which are unhelpful to recovery or they are simply untrue.  For example, many people continue to believe that a herniated disc will never heal.  Your physical therapist will redirect you towards what you can control and strategies to improve self-efficacy.

Often a large amount of active participation over a long time is needed to change unhelpful beliefs and poor lifestyle habits.  Your physical therapist will guide you towards forms of physical activity you prefer and which are appropriate.  It is also important that you fully understand the time it takes for the body to heal itself.  The body’s natural healing mechanisms can be enhanced with the appropriate dose of physical activity.  Start too slow and your recovery will be delayed.  Start too fast and “flare-ups” will kill your motivation. Your physical therapist will help you find the best starting point and teach you how to progress.

Exacerbations of pain are going to occur.  You are going to have “flare-ups” of your back pain, neck pain, or shoulder pain.  This needs to be accepted and expected.  You want to develop resilience for these set ups.  There are always strategies available to help you through these challenging times.  Thinking the worst is never helpful in these situations.  Remaining optimistic is the first step.  Next, identify what is under your control to get you back on track.  This is where your physical therapist can help you focus your efforts.

Closing Thoughts                         

People with persistent painful conditions don’t always need more medical treatment.  They need a coach or guide to show them how to manage on their own with active forms of treatment.  Physical therapists can fill this role.  Developing a positive working relationship, or therapeutic alliance, with your physical therapist will get you set on the right track.  The rest is up to you.

Exercise is Medicine for Depression

Depression can be a short-term state or a long-term clinical disorder.  Depression as a transient mood state is characterized by feeling sad, discouraged, or unhappy. These feelings generally resolve over the course of a few days or less.  Depression as a clinical condition is a psychiatric disorder where certain diagnostic criteria must be met.  The diagnosis of major depressive disorder requires psychiatric evaluation by a qualified professional. The diagnosis typically includes at least several of the following: weight loss, sleep disturbance, agitation, fatigue or loss of energy, feelings of worthlessness or guilt, diminished concentration, and possibly recurrent thoughts of death.  Major depressive disorder is distinguished from transient feelings of depression by both the severity and duration of symptoms.

It is estimated that one in five adults will suffer from major depressive disorder at some point in their life.  The incidence is higher in women.  One in four adolescents suffers from depression and this increases the risk of depression later in life.   Depression has also been linked to obesity, diabetes, and heart disease.  All of these disorders, including depression, are on the rise in the United States.   These disorders are also commonplace in outpatient physical therapy clinics where individuals are recovering from injuries.  Perhaps, the knowledge and positive habits learned in physical therapy can assist those with symptoms of depression and chronic disease.  Follow-through with a long-term exercise program can produce meaningful changes in mood, physical health, and quality of life.   All of these benefits can be achieved without the adverse effects associated with other forms of treatment.

Conventional Treatments for Depression

Antidepressant medication is the staple treatment for symptoms of depression.  Approximately half of individuals with depression will respond favorably to prescription medications without side effects.  The other half will either not respond to treatment or suffer side effects from the medications such as constipation, sleep loss, blurred vision, weight gain, fatigue, nausea, and sexual dysfunction.

Treatment may involve individual or group counseling lasting several months. Psychotherapy has been shown to be an effective long-term treatment for depression.  This form of treatment is often used in conjunction with antidepressant medication for individuals with more severe depression.   Cognitive behavioral therapy is one form of psychotherapy which aims to identify and change negative thoughts in those with depression.

Exercise as a Treatment for Depression

As a stand-alone treatment, exercise has been shown to result in moderate to large improvements in depressive symptoms.  Research has also shown no difference in outcomes when comparing exercise to cognitive behavioral therapy.  When combining the results from four studies, no differences were found between the effects of exercise and antidepressant medication.  This is not to suggest that medication and psychotherapy are ineffective.  Instead, exercise may enhance the effects of these conventional treatments for depression.  And perhaps, exercise may even be able to replace them over time.

Type and Dose of Exercise to Manage Depression

Most studies showing positive effects with exercise have included some form of aerobic exercise.  Walking, jogging, and cycling are the most commonly utilized forms of aerobic exercise.  The optimal frequency of exercise has not been determined but most studies have included exercising 3-5 times per week.  Programs with higher energy expenditures have been shown to produce greater results but positive effects can be achieved with lower intensity programs. A good starting point is to perform short walks 3 days per week.   As aerobic capacity and confidence improve, exercise should be progressed based on the American College of Sports Medicine recommendations of moderate intensity exercise performed for at least 30 minutes 5 days per week.  As aerobic capacity improves, exercise intensity and duration should be progressed in order to continue to make gains.

Tips to Increase Chances of Success

The first challenge with any exercise program is simply taking the first step.  Starting small and gradually building up the intensity, duration, and frequency is a wise approach.  Expect minor setbacks along the way and do not be discouraged when they occur.  The antidepressant effects of exercise takes time.  Be patient.   Once you begin to notice small progress in your exercise capacity and overall well-being, momentum will start to build.  The key to long-term adherence is to stay disciplined and develop habits for a lifetime.  Below are a few tips to help you on your journey.

  • Pick a form of exercise you enjoy and stick with it
  • Invest in a good pair of sneakers to exercise in
  • Pick a time of day to exercise which works best for you and make this part of your daily routine
  • Set your own goals and track your progress
  • Anticipate barriers (fatigue, work duties, bad weather, etc) and develop solutions ahead of time
  • Team up with a partner or partners and you will be more likely to stick with it
  • Do not be discouraged if you miss one session. If you fall off, get right back on the next day.
  • Take a minute and appreciate how you feel at the end of each exercise session

Let us know if you need help getting started and best of luck!

References

  1. Blumenthal JA, Smith PJ, Hoffman BM. Is exercise a viable treatment for depression? ACSMs Heal Fit J. 2012;16(4):14-21. doi:10.1249/01.FIT.0000416000.09526.eb.Is.
  2. Cooney G, Dwan K, Greig C, et al. Exercise for depression (Review). Cochrane Database Syst Rev. 2013;9:1-125. doi:10.1002/14651858.CD004366.pub6.www.cochranelibrary.com.

Finished Your Physical Therapy: What’s Next?

The day has come.  You’ve dedicated your time and put in the work now you and your physical therapist have decided you’re ready for discharge.  So what happens after you have completed physical therapy?

Some patients leave physical therapy feeling 100% and return to their regular active lifestyle and prior fitness routine.  In many cases, though the patients we see are ones that do not live an active lifestyle and have no prior fitness routine. Some patients may only feel 80% better and insurance benefits or financial limitations will not allow continued care. These patients, in particular, are the ones who may leave therapy feeling uneasy or unsure.  They may have many questions they are asking themselves:

  • What if I never feel 100%?
  • When will I find time to continue the home exercises on my own?
  • How long will I have to continue these exercises for?
  • What if the exercises feel like they aren’t helping me anymore?
  • Will I be disciplined enough to do them?
  • What if the pain starts to come back?
  • What if I stop doing the exercises?

Exercise After Physical Therapy

Chances are if you are asking yourself any of these questions, you may be someone who requires or would benefit from more guidance moving forward.  Ideally, you would benefit from a long-term fitness routine or group exercise program.  If you are someone who did not exercise regularly prior to staring physical therapy there is a good chance that you will not continue to do the exercise once you are done.  The intentions may be good but many people do fall short.  Some people are disciplined self-motivators but many are not.  Also, it is easy enough to say “I can’t find the time” or “life just got in the way”.   Anyone at anytime can find the excuse as to why they haven’t been able to continue with a routine.

Building Healthy Habits

Most of the time patients attend physical therapy for 2 or 3 visits a week for a few weeks, most commonly between 4 and 8 weeks.  Research says it can take 2 months or more (66 days on average) to form a new habit.  It takes repetition for the new behavior pattern to become imprinted in your neural pathways. In fact, research by Kaushal and Rhodes suggests it takes at least 4 gym sessions per week for 6 weeks to establish an exercise habit. That doesn’t mean you can’t develop an exercise habit by going less frequently; it just means it will probably take longer for it to become automatic.

If you have already been attending physical therapy 2-3 times per week DO NOT stop dedicating that time to yourself when you are done. DO NOT take a week off and decide to figure out the next step later. DO NOT lose your momentum! If you know that you are someone who needs that continued guidance and motivation ask your physical therapist to help you find the right exercise program to start with.  Depending on your fitness level, behavior characteristics and health goals there will be options that are better for some than others.  Fitness is a booming business right now and there are plenty of options out there.  Some people don’t know where to start.  Your physical therapist will have a general knowledge of what types of exercises are done at different fitness facilities, however, depending on where you live these places vary.

Local Recommendations

The physical therapists at BSR Physical Therapy have been doing the research locally here in the Manahawkin, NJ area.  We are helping to build a library of long-term fitness options for our patients.  We want you to succeed in your health goals.

Most recently Dr. Amanda Higgins, Morgan Gamble and I attended a barre class at Black Sheep Studios on LBI.  The fitness studio had a welcoming earthy vibe.  We met with one of the owners Devon who was as personable as they come and full of energy.  It only took one class to know that this is a place where you won’t get lost in the numbers as the class sizes are small and intimate and everyone called everyone else by name.  The instructors paid close attention to form and corrective technique which is a must to get the recommendation from a physical therapist.  Their instructor Wendy provides individualized programs for people with the use of pilates transformers which is a hard find in this area.  They also provide a menu of other unique exercise classes that may be the perfect fit for some of you.

This place is one of many that can help you stay on track.  We want to see you succeed with your health and fitness long term.  Let us help you transition from physical therapy to fitness.

-Dr. Amy McMahon

 

3 Proven Strategies to Achieve Your Goals in the New Year

Every New Year starts with well-intentioned resolutions to change behaviors and achieve personal goals.  However, it is estimated that only 8% of people actually follow-through with their New Year’s resolutions.  Setting and achieving goals, whether part of a New Year’s resolution or not, is a skill which can be learned with practice and a little resilience.  In order to have any realistic chance of achieving any personal goal, you have to clearly identify what it is that you want, make a plan to achieve it and then work on that plan every single day.

Begin with a Written List

Don't skip this step
Write down your goals

First, imagine that you have all the time, money, skills, education, and experi­ence that you need to accomplish any goal you can set for yourself.  Dream big!  Write down whatever goals come to mind in 30 seconds.  Your goals must be in writing. They must be clear, specific, detailed, measurable, and written in the past tense as if they have already been achieved.  Only 3% of adults have written goals and we call these people “successful”.  Those who do not put their list in writing do not have goals, they have wishes.  The simple act of writing down your goals cements them in your subconscious mind.  Without conscious awareness, you then begin taking small incremental steps towards achieving your goals.  Next, review your list and identify the one goal which if achieved would have the biggest impact on all your other goals.  This one goal is where you start.

The strategy of putting your goals to paper is a must do within any context including those related to health and fitness goals.  For example, I have a goal related to improving my back squat performance.   My goal is as follows, “I have improved my 1-repetition maximum back squat to twice my bodyweight by the end of 2018.”  This goal is written on paper and visible on my mobile phone every time I access it.   The goal is clearly visible in my mind and not a day goes by where I will not be reminded of it.  Life’s challenges can never derail me from working on this goal.  What is your most important health or fitness goal for the New Year?  Write it down.

Develop Your Plan

Plan your success
Don’t make wishes. Set goals.

Planning starts with writing down a list of every single step that you can think of that you will have to follow to ultimately achieve your goal.  When you write out a list of all the things you will need to do to achieve your goal, you begin to see that your goal is far more attainable than you originally thought.  Next, organize your list by arranging the steps that you have identified by priority.  Identify the most important steps and begin working on them first.  The 80/20 Rule says that 80% of your results will come from 20% of your activities.  What are your 20% of activities which will make the biggest impact on achieving your goal?

Returning to my goal of improving the back squat, there are endless steps I could pursue to achieve this goal.  However, through several hours of deliberation and re-writing of my goals and priorities, I have arrived at the 3 biggest activities which will lead to goal achievement.  I will prioritize squat technique practice, gluteus maximus strength, and thoracic spine mobility.  Now, I have a clear goal, list of steps needed to achieve my goal, and clear priorities to focus on.  What is your plan to achieve your biggest goal for the New Year?

Work on Your Plan Every Day

Put first things first
Work on your plan every day

Your plan to achieving your goal and working on your priorities needs to be broken down into actionable steps.   Start by planning each day, week, and month in advance.  Plan each month at the beginning of the month.  Plan each week the weekend before.  And most importantly, plan each day the evening before.  Write down these actionable steps and then tackle the most important ones at the start of each day.  Don’t put off the most important steps to the end of the day, week, or month.  Procrastination only leads to frustration anda sense of  loss of control over your goal.

Every morning I ask myself, “If I could only do one thing all day long, which one activity would contribute the most value to my goals?”  Returning to the squat, this might include performing a series of thoracic mobility exercise first thing in the morning before the rest of the world is coming at me full speed.  Your ability to select your most important task and then to work on it with purpose, without distraction, at the start of your day will build momentum towards achieving your ultimate goal.  What is the most important action you can take at the start of your day to get you closer towards your goal?

Final Thoughts on Goals

Decide exactly what you want, write it down, make a plan, and work on it every single day.  If you commit to these strategies and develop positive habits, you will accomplish more in the next few weeks than many people accomplish in a year.  Join the 8% of people who actually turn dreams into goals and goals into reality.  Get started today and don’t look back.